Two People, Two Options: living healthy or dying prematurely

This weekend has been a challenging one, as I received two pieces of news. The first was of one client’s incredible success following the low carb high healthy fat diet and the shocked reaction of his doctor, and the other was of the death of a friend who had Diabetes, high blood pressure and high cholesterol. In this blog, I will share how these two events embody the two options each of us have; (1) living a healthy life to the fullest or (2) living with diet-related disease and dying prematurely of ‘natural causes’.


“JP” – a Picture of Success

Last fall, I had a reasonably fit 35-year-old client contact me wanting to lose 15 pounds. He went to the gym twice a week for an hour, and ran 10 km per week, but had put on some pounds and wanted to lose them.

As I always do, I asked for a copy of recent blood test, assessing his fasting blood glucose, HbA1C (3 month average of blood glucose), cholesterol (lipid panel) and requesting his doctor-assessed blood pressure. (Sometimes people insist that I counsel them without seeing blood work, but I explain that they ran out of crystal balls when I was graduating, so I have no choice but to get labs.)  I gave my new client a Lab Test Request form to bring his doctor.  The GP scoffed at the Lab Test Request Form asking him to requisition a lipid panel for a young, fit 35 year old whose parents are both living. That changed when the tests came back, and this man’s triglyceride level was higher than I had ever seen anyone’s, ever. His non-HDL cholesterol was very high and his HDL was very low. LDL wasn’t even available because his triglycerides levels were through the roof. His ferritin was astronomically high – not a sign of excess iron, but likely inflammation.

His doctor called him into the office immediately and wanted to put him on statin medication right away and referred him to the Lipid Clinic at a major local hospital.

My client told his doctor he wanted to wait 3 months and first follow my dietary recommendations and see what would happen to his lipids, and was advised against it by his doctor. My client was insistent, so the doctor told him that his recommendations were for him to eat “decrease saturated fat and carbohydrates, increase fruit and vegetables, increase insoluble fiber and fish, make his plate 1/2 vegetables, 1/4 protein, 1/4 starch“.

After seeing me, he agreed to limit fruit to max 1 / day, preferably a few berries on top of 2 or 3 huge salads with plenty of good quality olive oil and to have most of his carbs as vegetables. He learned that “not all vegetables are created equal” and I taught him to differentiate between those he could eat as much as he wanted at each meal and those he should limit or avoid. We talked about milk consumption, and the health benefits of eating plenty of fatty fish, such as salmon, mackerel and fresh sardine. And we talked about carbs. We talked a lot about carbs. Carbs in fruit, carbs in milk, carbs in bread, pasta and rice, and carbs in vegetables. 

I designed an Individual Meal Plan for him, making sure he obtained sufficient macronutrients (protein, fat and carbs) as well as micronutrients (especially potassium, magnesium, sodium, vitamin C and calcium, vitamin D and vitamin K) – and factoring in his desired weight loss. I explained that if he followed his Meal Plan, it is perfectly reasonable for his triglyceride levels to be <2.00 mmol/L in 2 more months. 

Three weeks later, his doctor ran his labs again.  His triglyceride level was almost a third what it was! His non-HDL was down substantially and his HDL was rising nicely. When he was seen at the Lipid Clinic, they were willing to give him 2 more months to get his lipids in the normal range before starting him on medication.

Friday, he wrote me telling me that his triglycerides we down well below 2.00 mmol/L and added;

“this amazed the doctor!”

My client left his doctor’s office without a medication prescription and with only the recommendation to keep eating the way I taught him. My client added that he was already within 2 – 3kg of his goal weight.

It’s not magic.

The doctor should not have been amazed that diet alone can be this effective – even for someone for whom high cholesterol has a genetic component. The literature documents the role of a low carb high fat diet.

But it is easier to write a prescription than educate a patient. 


My High School Friend – preventable premature death

Last night I learned that my friend since high school, died from natural causes. She had Type 2 Diabetes, high blood pressure and high cholesterol. She and I were the same age.

Three years ago, when my friend was first diagnosed as having Diabetes, she asked my opinion about having received Diabetes counselling in her province to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at each of 3 snacks – that’s 180 gm of carbohydrates per day.  A mutual friend of ours from the same province, who had also been recently diagnosed with Diabetes confirmed that she too was advised to eat 45 gm of carbohydrates at each meal and at least 15 gm of carbohydrates at snacks. At that time, I had explained to my friend what I had been learning about the role of excess carbs in Diabetes, hypertension (high blood pressure) and high cholesterol. While I provide distance consultations in my practice (using a combination of phone, email and fax), as Dietitians we are advised specifically not to provide dietary counselling to family members or friends. With my ability to help directly being very limited, I recommended that she find a Dietitian near her who could teach her about managing this triad (called “metabolic syndrome“) using a low carb high fat diet. She followed the standard dietary recommendations to the letter and took her multiple medications as prescribed. Her blood sugar levels came down using medication (but that was effectively treating the symptom of high blood sugar, not the cause which is the underlying insulin resistance). Her blood pressure kept going higher and higher despite medication, so more medication was added.  She then developed high       cholesterol.      

Today, my friend is dead, in what may have been an entirely preventable, premature death.

So I am left asking myself ‘could following the standard recommendations of eating 180 gm of carbohydrate per day (or more) with Type 2 Diabetes, high blood pressure and high cholesterol — without treating the underlying cause (insulin resistance) have contributed to her death’?

The literature is certainly full of studies documenting the beneficial effects of a low carb high fat diet on metabolic syndrome – but she was never given that as an option.  She was prescribed medication for lowering blood sugar and blood pressure, but nothing was done to lower her insulin resistance.

A lifetime of work by the late Dr. Joseph Kraft with almost 300,000 people documents that it is the insulin resistance that underlies cardiovascular disease  not the high blood sugar. Furthermore, 65-75% of people with normal blood sugar levels still have insulin resistanceand the same elevated risk of having a heart attack. 

We keep treating the symptoms and people keep dying anyways – and those without any symptoms are walking around with elevated risk of dying from cardiovascular disease, and don’t even know it.

We are told;

“Diabetes is a chronic, progressive disease”

which means that once diagnosed with Diabetes, you’ll have it forever – and that eventually it will get worse, requiring medication, then more medication and finally insulin.

When people have bariatric surgery (“stomach stapling”), their blood sugars come back to normal within weeks and at the end of a year, they no longer have any of the clinical symptoms of Diabetes.  Their fasting blood glucose levels are normal and their HbA1C levels are normal. They are essentially as if they don’t have Diabetes. Their Diabetes is in remission.

So is Diabetes REALLY a “chronic, progressive disease”? No, it can be stopped.

If the reason people became Diabetic was because of how they were eating, why is it SO hard to grasp the concept that they could get well, but changing how they are eating?

At the end of the day, we have a choice.

We can do as my client above did and put everything we have into changing how we eat based on good, sound scientific studies and with medical supervision, or we can keep doing what we’ve been doing, expecting different results.

I made my choice a month ago tomorrow, and will write an update in the blog titled “A Dietitian’s Journey” tomorrow, for week four  (see Food for Thought tab, above).  Here’s a teaser; two days ago my blood sugar levels were several times at normal levels – and were overall much lower than a month ago. Last night (twice) and once this morning, my blood pressure was in the normal range.  One month!

I ask myself, what will my labs look like in 3 months or 6 months of addressing the underlying insulin resistance (instead of the symptom of high blood sugar?) What will be life be like, when I have normal blood sugar levels and normal blood pressure and normal cholesterol levels?

It will look better than the alternative.

Rest in peace, dear friend.


If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

 

 

Significance of Insulin Resistance

Insulin resistance is a condition where your body keeps producing more and more insulin in order to transport glucose out of the blood and store the excess by converting it to fat. When cells have become resistant to insulin, glucose builds up in the blood and results in “high blood sugar”. The problem is that high blood sugar is a symptom of the problem, it is not the problem itself.  Insulin resistance is the underlying cause and is highly significant to those with completely normal blood sugar levels.

Those with high fasting blood glucose may notice symptoms that are associated with Type 2 Diabetes; including excess urination and excess thirst. This is the body’s way of trying to dilute the high levels of glucose in the blood. A very sobering fact is that 75% of people with insulin resistance have normal fasting blood glucose levels and don’t know that they are insulin resistant.

They have NO symptoms whatsoever.

They don’t know that they are at increased risk for heart attack and stroke.

The Silent Risk of Insulin Resistance

Insulin resistance is a risk factor for atherosclerosis* – also called “hardening of the arteries”. Atherosclerosis is where plaque builds up inside the body’s arteries and if the plaque build-up occurs in the heart, brain or kidney, it can result in in coronary heart disease, angina (chest pain) or chronic kidney disease. These diseases are normally associated with Diabetes, but it is the underlying insulin resistance of Diabetes that creates the increased risk – not the high blood sugar itself.  Worthy of note, it is being insulin resistance that increases one’s risk – whether or not one also has high blood blood sugar.

The plaque that builds up in atherosclerosis may partially block or totally block blood flow to the heart or brain and if a piece of the plaque breaks off or if a blood clot (thrombus) appears on the plaque’s surface – this can block the artery  resulting in a heart attack or a stroke (in the brain).

Three quarters of people with normal fasting blood glucose are at increased risk of atherosclerosis and as a result, to heart attack and stroke due to insulin resistance and they don’t even know it, because their blood sugar is normal!

* a few recent references (there are many more):
Pansuria M, Xi H, Li L, Yang X-F, Wang H. Insulin resistance, metabolic stress, and atherosclerosis. Frontiers in Bioscience (Scholar Edition). 2012;4:916-931. 

Santos, Itamar S. et al., Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline, Atherosclerosis 2017 Mar 10;260:34-40

Insulin Resistance with Normal Blood Glucose

Dr. Joseph R. Kraft, MD was Chairman of the Department of Clinical Pathology and Nuclear Medicine at St. Joseph Hospital in Chicago, Illinois for 35 years. He spent a quarter century devoted to the study of glucose metabolism and blood insulin levels.

Between 1972 and 1998, Dr. Kraft measured the Insulin Response to a carbohydrate / glucose load in almost 15,000 people aged 3 to 90 years old using a 5-hour oral glucose tolerance test with insulin assays. Data from 10,829 of these subjects indicated that 75% of subjects were insulin resistanteven though their fasting blood sugar level was normal.

That is, having a normal fasting blood glucose level, and normal HbA1C level does not preclude someone from being insulin resistant and at increased risk for heart attack and stroke.

The American Heart Association states on its web page that;

“exactly how atherosclerosis begins or what causes it isn’t known, but some theories have been proposed. Many scientists believe plaque begins to form because the inner lining of the artery, called the endothelium, becomes damaged. Three possible causes of damage to the arterial wall are (1) elevated levels of cholesterol and triglycerides in the blood (2) high blood pressure and (3) cigarette smoking“.

It is known that high triglycerides in the blood are largely a result of diets high in carbohydrates where excess carbohydrate that isn’t converted to glycogen and stored in muscle and liver is stored as triglyceride (three fatty acids attached to a glycerol molecule).

Insulin resistance in our cells, results in our bodies releasing more and more insulin in order to try to clear the same amount of glucose from our blood to store it in our liver as triglyceride (fat!). As covered in the blog post on the hormonal effect of insulin, it is the insulin which drives increased hunger and specifically increased craving for carbohydrates.  A viscous circle is created.  Diets that are 45-65% carbohydrate result in more and more insulin to handle the same carb load (that is the very nature of insulin resistance) and this increased insulin leads to even more insulin resistance, increased hunger and craving for….you guessed it: more carbs.

Since insulin’s main role is to store the excess glucose not needed immediately to fat – our bodies produce more and more triglyceride (fat!) the more carbs we eat and the more insulin resistant we are. That is, a high carb diet results in high triglycerides – which the American Heart Association recognizes as playing a role in the development of atherosclerosis. That is because triglycerides are converted to VLDLs to transport fat around the body and when their triglycerides ‘passengers’ are depleted, what is left is LDL, the “bad cholesterol” we have all heard about.  The ONLY source of LDL is VLDL, and high triglyceride is largely the result of a diet that is too high in carbohydrate.

Insulin also plays a significant role in the regulation of blood pressure through its effect on sodium transport. As insulin rises, excess sodium is retained by the kidneys, increasing blood pressure.  Insulin resistance compounds this problem, causing blood pressure to rise even more.  It has long been known that people with Diabetes develop high blood pressure – but it is the underlying insulin resistance that is driving that, not the symptom of high blood sugar.

What is alarming is that based on Kraft’s research with ~11,000 people over 20 years, potentially 75% of people are insulin resistanteven though their fasting blood sugar level is normal. This insulin resistance drives the increased triglycerides and high blood pressure that characterize what the American Heart Associations states is believed what underlies the development for atherosclerosis – and the corresponding risk of heart attack and stroke.

Could insulin resistance be a silent killer?

Kraft’s Patterns of Insulin Response

Kraft plotted the data from ~11,000 subjects and five distinct Insulin Response Patterns emerged.

Insulin Response Curves – image adapted from Dr. Ted Naiman

‘Pattern I: is a normal, healthy insulin response to a standard glucose load. Dr. Kraft called this ‘Euinsulin’.

image by Joy Y. Kiddie MSc RD
Pattern I: Normal Insulin Response Curve

Pattern II – is a hyperinsulinemic insulin response to a standard glucose. Note that Pattern II is considerably greater than the normal insulin response curve (Pattern I) and this greater insulin response is sustained for 5 hours after the ingestion of the glucose. 

image by Joy Y. Kiddie MSc RD
Pattern II hyperinsulinemia compared to normal glucose response (Pattern I)

Superimposing the hyperinsulinemic insulin response of Pattern II over the normal Pattern I insulin response curve, it is easy to see how much higher the Pattern II (yellow curve) is over the normal Pattern I (green) curve.  This is the early stages of insulin resistance.


Pattern III – is a hyperinsulinemic insulin response to a standard glucose load. Compared to the normal insulin response curve (Pattern I), it much greater during for 5 hours after taking in the glucose.

image from Joy Y. Kiddie MSc RD
Pattern III hyperinsulinemia compared to normal glucose response (Pattern I)

Superimposing Pattern III (hyperinsulinemia) insulin response curve over the normal (Pattern I) insulin response curve, its easy to see how the insulin response is delayed (skewed to the right). This results in blood glucose remaining high, as insulin is not responding as it should. Keep in mind, this is occurring in people with normal fasting blood glucose levels.

The Pattern III curve also goes so much higher than the normal Pattern I insulin response curve – which means that more insulin is released and this higher insulin release is sustained for the 5 hours after taking in the glucose.

This is “silent” pre-diabetes  delayed insulin response and much higher levels of insulin for a much longer time – but with normal fasting blood glucose!


Pattern IV – Pattern IV is what Dr. Kraft calls “Diabetes in Situ” – literally “Diabetes in Place”. Looking at the Pattern IV insulin response curve compared to Pattern I (the normal insulin response), it is apparent that it is much greater for the entire 5 hours after taking in a standard amount of glucose.

image created by Joy Y. Kiddie
DIABETES IN-SITU: Pattern IV insulin response points compared to the normal Pattern I insulin response curve (in green)
image created by Joy Y. Kiddie MSc RD
DIABETES IN-SITU: Pattern IV insulin response curve compared to the normal Pattern I insulin response curve (in green)

Surprisingly, 40% of people with a Pattern IV Insulin Resistance still had normal fasting blood glucose

75% of people displaying Pattern II, II or IV insulin responses do not know that they are at greater risk for atherosclerosis and as a result to heart attack and stroke because they have no symptoms.  Their blood sugar levels are normal.

Finally, insulin resistance is the most common cause of Type 2 Diabetes.

Normal fasting blood glucose and normal HbA1C results do not reveal whether or not a person is insulin resistant – only a 2 hr glucose tolerance test can do that. Unfortunately, a 2 hour glucose tolerance test is usually only requisitioned when fasting blood glucose and HbA1C results come back abnormal.

Potentially, up to 75% of people are insulin resistance and have NO IDEA!

They are at increased risk for heart attack and stroke and have NO SYMPTOMS.

They don’t have increased thirst or increased urination like Type 2 Diabetics, but are at the same risk.

The Good News

The good news is, we can lower insulin resistance – and as a byproduct of that, shed excess weight in the process. This is accomplished through (1) a low carbohydrate diet with or without the use of (2) stretching the amount of time between meals (sometimes called “intermittent fasting”).

When designed properly, a low carbohydrate diet can provide all of the recommended intake of vitamin and minerals – while lowering insulin resistance.

That is where I come in.

I can assess your physiological needs for energy and nutrients and design an Individual Meal Plan that will enable you to lose weight, without being hungry all the time – and that will help lower your insulin resistance and the associated risk of cardiovascular disease related to insulin resistance.

Want to know more? Click on the “Contact Me” tab above and send me a note.

To our good health!

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2017 The Low Carb High Fat Dietitian (a division of BetterByDesign Nutrition Ltd).  LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 


follow me at:

 https://twitter.com/joykiddieRD

  https://www.facebook.com/lchfRD/

A LCHF Diet

low carb high fat (LCHF) diet is a way of eating that maximizes the body’s natural ability to access one’s own fat-stores for energy. Fat takes the place of carbohydrate as the preferred source of energy, so most of the body’s energy needs comes from a wide variety of healthy fats. All low carb high fat diets minimize carbohydrate-based food, have a moderate amount of protein and high amount of healthy fats, some versions (e.g. Phinney and Volek) have higher protein and lower fat during the weight loss phase.

When we eat this way, our body uses dietary fat that we eat and our own stored fat for energy and by keeping carb intake low, insulin levels are allowed to fall, which in time makes our cells more sensitive to it. As insulin levels fall, so does hunger – so we eat meals when hungry, until we are no longer hungry – but are no longer hungry every few hours.

The low carb high healthy fat diet

These are the categories and types of food that are available to enjoy on a low carb high healthy fat diet

Low Carb High Healthy Fat – food categories (acknowledgements: adapted from an illustration by Dr. Ted Naiman)

Macronutrients

The exact ratio of macronutrients in your diet (i.e. grams of carbs, fat and protein) will differ depending on your age, gender, activity level, current body composition as well as any health conditions or medication you may be taking – and of course, which style of low carb high fat diet you follow.

Here are some general guidelines to give you an idea;

Protein

A low carb high healthy fat diet does not have unlimited amounts of animal protein, although some variations of this style of eating do. As mentioned above, some versions of this eating style have higher amounts of protein than fat only during the weight loss phase.

Fat

One thing all low carb high fat diets have in common, is that they are lower in carbs than the conventional low fat calorie-restricted diet and high in fat.

During weight loss, some approaches have ~60% fat and higher amounts of protein, whereas others have 75-80% fat (e.g. Fung’s approach) and moderate amounts of protein.  But isn’t all this fat “bad” for us – especially saturated fat?

It’s important to keep in mind that only ~ 20% of the saturated fat in our body comes from diet, with the remainder being made by our body. If it were that ‘bad’ for us, why would our bodies naturally manufacture it?

How much saturated fat should we eat?

According to Phinney and Volek (The Art and Science of Low Carbohydrate Living), when someone is adapted to eating a low carb high healthy fat (i.e. are in “fat-burning mode”), saturated fats do not raise LDL cholesterol. That said, why eat only saturated fat? Eating a wide range of healthy fats from a variety of natural sources provides our bodies with all the essential fatty acids we can’t make, as well as provides us with foods that can reduce inflammation.

Beyond saturated fat that is found in the diet’s protein sources (meat, fish, egg, cheese and poultry), I recommend that people look mainly to mono-unsaturated plant-based fats such as those found in avocado, olive,  and avocado oil along with saturated fat and medium chain triglycerides from coconut oil (processed through the lymphatic system rather than the liver), modest amounts of  omega 6 fats from nuts and seeds, as well as plenty of omega 3 fats found in fatty fish.

It’s important to note that nuts and seeds such as almonds, walnuts, pumpkin and sunflower seeds, pistachios are a source of carbs (ranging from ~1.5–4 grams net carbs per ounce (30g)), so it’s important to use these in moderation, such as a few as a topping for a salad. In addition, nuts are high in omega-6 fats which are pro-inflammatory as they compete for binding-sites with omega-3 fats such as those found in fish.

Chia and flax seed are approximately 1–2 grams net carbs per 2 Tbsp (50 ml) and are excellent sources of both soluble and insoluble fiber.

All fats on the meal plan are healthy – which is why I call this approach “low carb high healthy fat”, but for a small percentage of people for whom high LDL cholesterol continues to be a concern, eating less saturated fat may be beneficial. Each person’s needs and familial risks are different, so no one low carb high healthy fat Meal Plan is the same.

Carbohydrate

Carbs are a healthy part of the low carb high fat diet, but the quantity of carb is minimized.

There are naturally-occurring carbs in non-starchy vegetables and low-sugar fruit (such as lemon, lime, eggplant, cucumber and tomatoes) as well as berries, as well as those found in nuts and seeds, as mentioned above.

Some versions of a low carb diet do not include nuts, seeds or berries during weight loss.

When starting a Low Carb High Healthy Fat Diet

Although not everyone does, some people experience some of the following symptoms, which usually subside within a couple of weeks. For each, I have offered some suggestions to minimize them:

  • headaches: often a result of eating too little salt. As insulin levels fall, so sodium is excreted by the kidney in urine. The drop in sodium results in the headache.  Taking 1-3 gms of salt per day (I prefer sea salt) will alleviate this. If you are taking medication for high blood pressure, be sure to check with your doctor before making any changes to your diet.  “Bone broth” is another way to restore electrolytes that are lost as insulin levels fall. Be sure you’re drinking plenty of water and also consuming enough salt/sodium.
  • sleep disruption: often a result of needing to urinate more, but sometimes experienced when people of switching from being in “carb-burning mode” to being in “fat burning mode”. Some people find taking some magnesium (with calcium) before bed helpful.
  • digestive changes: some people find they get slightly looser stools or get slightly more constipated when starting.  I can help troubleshoot this with you to get things back on track.
  • aches and pains: some people feel a little achy and almost flu-like for a few days when they are switching fuel sources.  Some people call this the “keto-flu”.  Making sure to have a balanced amount of sodium/potassium and calcium/magnesium as well as taking extra omega 3 fatty acids is helpful.

My role as a Dietitian

As a Dietitian, I make sure that you understand the effect that following a low carb high healthy fat diet can have on your body.  If you are taking medication for high blood pressure  (hypertension) or to lower blood sugar, I’ll ask you check with your doctor before starting, as blood sugar and blood pressure medications may need to be adjusted lower, as insulin levels fall.

If you aren’t taking any medication, I’ll help you transition into understanding that fat in and by itself is not ‘bad’ and that eating good quality healthy fats, nutrient-dense carbohydrate-containing foods and high quality animal protein is part of a healthy diet that will enable you to feel better, lose weight and lower insulin resistance.

I’ll design your Meal Plan so that it is adequate in macronutrients (protein, carbohydrate and fat) as well as micronutrients (vitamins and minerals – especially Calcium, Magnesium, Potassium, B-Vitamins, Vitamin A, Vitamin D, Vitamin K and Vitamin C) and sufficient in soluble and insoluble fiber  – suitable for your age, gender and activity level, and that factor in any diagnosed medical conditions you may have.

I’ll make sure that you are eating sufficient food in each of the food categories to meet your dietary needs, while adjusting for weight loss, if that is also a goal – so that you can just focus on eating healthy, ‘real food’.

Have questions? Feel free to send me a note using the form on the Contact Me tab, above.

To your health!

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/


Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2017 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

The “Skinny” on Fats

INTRODUCTION:

Many people believe that saturated fat is “bad” for you but few people realize that our bodies actually manufacture it.  It’s true. In this article, I cover “just enough” chemistry (made very easy!!) for you to be able to understand the latest new findings. My next article will be on a change in the dietary recommendations of a key stakeholder in heart health in Canada, and what this change means.


If Saturated Fat was so Dangerous, Why Would our Body Actually Make it? 

There are two sources of fats (also called “lipids“); those we eat in our diets and those our body makes. The fats we eat are called “exogenous fats” (“exo” meaning ‘from outside’) and the type of fats that our body makes are called “endogenous fats” (“endo” meaning ‘from within’).

Exogenous Fats

The types of fat that our body takes in as exogenous lipids from what we eat include saturated fats, and different kinds of unsaturated fats — including polyunsaturated fats — both omega 3 and omega 6, as well as monounsaturated fats. You can look back to the preceding blog, if you aren’t clear on these.

Endogenous Fats

Our body actually makes fat in a process called lipogenesis. This is important because some of the LDL cholesterol and triglycerides (TG) that gets reported on blood test results is endogenous; that is, our bodies made it. So we have high LDL (“bad” cholesterol) or triglycerides it’s not all from the fat we eat!

[Not only do our bodies make saturated fat, but excess carbohydrates gets stored in our body first as triglyceride and then if it still isnt needed, it gets stored as LDL cholesterol in our liver.  So carbs can raise both triglycerides and LDL cholesterol.]

Below, I will present just enough chemistry to understand the different types of fat and more importantly, be able to read about them and understand.

The Saturated Fat Our Body Makes and What it is Used For

1. The first thing that you need to know is that palmitic acid is a long-chain saturated fat is made (synthesized) in the liver. Palmitic acid is a 16-carbon fatty acid and having so many carbons in its backbone, it is considered “long chain”). It has no double bonds, so all the carbons in the backbone have a hydrogen bound to it (more on that below), so palmitic acid is a saturated fat.  Palmitic acid is found naturally in foods such as butter, cheese, milk and meat — but it is also synthesized by our bodies!

Now the message of the media since the mid- to late-1970s is to eat low-fat dairy; including low fat milk, low-fat yogourt and low-fat cheese with the assumption that saturated fat is “bad” for us — but our bodies actually manufacture it!


2. The other thing that you need to know is that a triglyceride is made up of three fatty acids attached to a glycerol molecule. That’s easy to remember, because “tri” means “3”.

a) Glycerol acts as the support for the other fats and is made up of three carbon atoms, each with something called a “hydroxyl group” bound to it.

A hydroxyl group (written “-OH”) is an oxygen and a hydrogen molecule bound together.  That is, water (H2O) is just a hydrogen (H) molecule bound to a hydroxyl (-OH) group.

So, this is a glycerol molecule;

As you can see, each of the carbons in the chain have a hydroxyl (-OH) group bound to it. Easy, so far, right?

b) Fatty acids are long chains of carbon atoms (i.e. think of a freight train, where each rail car is a carbon atom) with a carboxylic acid (-COOH) group at one end (i.e. the caboose is a carboxylic group). At each of the carbons in the chain, there is the potential for a hydrogen atom (H) to bind there.

You may recall from our previous article that a saturated fat is one that has no double bonds in the carbon chain, so in that case, all the carbon atoms in the chain have a hydrogen attached.  It is having all the carbons “saturated” with hydrogen atoms, that make it a “saturated” fat!

The names given to fatty acids are based on the number of carbon atoms and the number of carbon-carbon double bonds in the chain.


Different Kinds of Oils 

Remember, a triglyceride is made up of three fatty acids attached to a glycerol molecule. So, for example, palmitic acid and stearic acid are both exactly the same, except one has 16 carbons (palmitic acid) and the other has 18 carbons (stearic acid) in its chain.

Palmitic acid, a saturated fat has 16 carbons.  That is, it is “saturated” with hydrogen atoms at each of its 16 carbons. It is all of this “saturation” that makes saturated fat solid at room temperature.

Stearic Acid, is also a saturated fat, but has 18 carbons, so each of its carbons has a hydrogen bound to it,

Using just these two saturated fatty acids (palmitic acid and stearic acid) we can combine them in different ratios to make entirely different oilsFor example, canola oil has a 4:2 ratio of palmitic acid to stearic acid and grapeseed oil has an 8:4 ratio of palmitic acid to stearic acid.

Furthermore, the same two fatty acids can be put together in the same ratio and be different fats. For example in a 7:2 ratio, it could be either almond oil or safflower oil — depending on how they are put together.

Palmitic acid, the saturated fat that our body makes is found in all kinds of “healthy” foods.

Lipogenesis – Our Bodies Making fat!

Lipogenesis is the process by which our bodies actually make fat and our bodies can make unsaturated fats or saturated fats.  

Unsaturated fatty acid lipogenesis

Our body can make a longer chain unsaturated fat from a shorter chain fatty acid (such as taking the linolenic acid from flax seed and adding carbons to the chain to make arachidonic acid). But there are limits.  Our bodies cannot take the linolenic acid from flax seed and make it into eicohexanoic acid or decahexanoic acid which are the healthy “omega 3 fats” fats found in  fish. So eating eggs made from chickens fed flax is not the same as eating fish.  We just can’t turn one into the other. Our body can make it longer, but not much longer.

Saturated fatty acid lipogenesis

As said above, our bodies synthesize palmitic acid, a 16 carbon saturated fat in our liver and then forms a triglyceride from three palmitic acid molecules attached to a glycerol molecule. These triglycerides are then transported around the body in something called a VLDL. More on that just below. 


Cholesterol – The Good the Bad and the Ugly

Most people know that HDL cholesterol is the so-called “good cholesterol” and LDL cholesterol is the “bad” cholesterol  — but where does LDL (“bad cholesterol”) come from? The first step when our body makes something called VLDL.

Very Low Density Lipoproteins (VLDL)

The body takes the triglycerides it manufactures in lipogenesis as well as takes in in the diet into Very-low-density lipoprotein (VLDL) cholesterol. These VLDLs move cholesterol, triglycerides and other lipids (fats) around the body.

VLDL is produced in the liver and include the triglycerides made with differing amounts of palmitic acid.  That is, our bodies MAKE palmitic acid in the liver and then combine the palmitic acid it makes in differing ratios, into triglycerides. It then takes the triglycerides, containing palmitic acid and protein and packages it into VLDLs. It then releases the VLDLs into the bloodstream, to supply body tissues with triglycerides.  About half of a VLDL cholesterol is made up of triglycerides, including those containing the palmitic acid it made!

High levels of VLDL cholesterol have been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.

VLDL cholesterol on blood test results aren’t measured, but estimated as a percentage of the triglyceride value.

What is LDL cholesterol?

When VLDL cholesterol reach fat cells (called “adipose tissue”), the triglyceride is stripped out and absorbed into fat cells. That means that VLDLs shrink.

Once a VLDL has lost a large amount of triglyceride it becomes a new, smaller, lipoprotein, which is called Low Density Lipoprotein, or LDL — the so-called ‘bad cholesterol’. LDL contains mostly cholesterol and some protein. Some LDLs are removed from the circulation by cells around the body that need the cholesterol contained in them and the rest is taken out of the circulation by the liver.

Here is the key point: the only source of LDL is VLDL. 

Saturated Fat — not dangerous and can be beneficial 

The media keeps telling us that “saturated fat is bad” and that it is even “dangerous” — but if it was so dangerous, why would our bodies actually manufacture it?  Our bodies manufacture palmitic acid, a saturated fat, then synthesize triglycerides from it which it sends all around our bodies, supplying our bodies with saturated fat!

Furthermore, there are some saturated fatty acids, called Medium Chain Triglycerides (MCTs) that are metabolized entirely differently than the longer chain saturated fatty acids and have beneficial properties.  These MCT oils go straight to the liver by the portal circulation and don’t need to be digested.

People who consume fats high in MCT oil, such as coconut oil which is almost half (44-55%) Lauric acid, an MCT have been found to have lower amounts of “belly fat” than those that do not consume these saturated fats.  Studies have found lower rates of “visceral adiposity” or “belly fat” in those that consume these fats, and correspondingly , lower lowering waist circumference.

Since carrying fat around the abdomen (the so-called “apple shaped” people) is considered to be a risk-factor to heart disease and studies have found that those who eat a diet high in MCT saturated fats have less fat around their middles and a smaller waist circumference, can we categorically say that saturated fat is really “bad” or “dangerous” to heart health. In fact, in our next article, we will outline the beginning of a change in the recommendations concerning saturated fat consumption.

Some thoughts…

Saturated fat and its consumption needs to be put into context; one context would be looking at the risks of a high carbohydrate diet compared with a high saturated fat diet, for example.  As covered in previous blogs, prior to 1977, when the dietary recommendations in Canada and the US changed to favour a diet low in saturated fat and high in carbohydrates, the rate of Diabetes was 1/10th what it is now and obesity rates in adults, especially men were too. Childhood obesity was almost unheard of prior to 1977.

Another context would be to differentiate between saturate fats.  That is, to look at which saturated fats.  Numerous studies demonstrate the benefits of MCT oils in increasing metabolism, lowering body fat, especially “visceral adiposity”.

Another context would be to determine how much of the “high cholesterol” (i.e. high LDL cholesterol) came from VLDL that was endogenously produced, versus eaten (exogenous).

Many studies have found that people are less hungry (have increased “satiety”) when they consume higher fat dairy products (which are rich in saturated fat), and as a result consume less calories overall than those that do not eat higher fat dairy products. So, we need to know which fats, and in particular which saturated fats are associated with this increased satiety?

It is my opinion that “vilifying” fat — labelling it as ‘unhealthy’ and the current government dietary recommendations and the media ads encouraging us to eat “low fat” everything, is creating a much bigger problem than the fat itself.  When manufacturers take out fat, they have to ‘replace” it with something and that ‘something’ is often sugar (simple carbohydrates).  Is increasing the carbohydrate content ‘safer’ than the naturally occurring fat that was found in the milk or yogourt or cheese, in the first place?

Recent studies seem to indicate that saturated fat consumption is not the issue when it comes to heart risk — and that saturated fat may actually be protective against heart risk. Certainly there are many studies showing the benefits of consuming MCT oil for reducing “belly fat”, which reduces heart risk — so can we say that something like coconut oil, used in moderation is “bad” or “dangerous”.

Looking at the epidemiological data from the last 35 years, we can see what has happened to obesity rates and diabetes rates since both the American and Canadian governments have been encouraging us to eat “low fat” everything.

Are naturally occurring fats really the issue — or are synthetic “trans fats” and excess carbohydrate?

At this point in time, I am persuaded by the many studies I have read, that naturally occurring fats, including saturated fat are not “bad” or “dangerous” when consumed as part of a whole-foods diet.

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2016 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


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Carbs or Fat – which one should we eat less of?

lipids-and-fats-11-638

Intro: Since 1977, Health Canada and Canada’s Food Guide have been promoting a diet which is high in carbs (45-65%) and low in fat (20-35% ) and which recommends that no more than 7% of fat comes from saturated fat — with the goal of lowering heart disease.

As elaborated on in an earlier blog, prior to 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10% and in 1978, only 15% of children and adolescents were overweight or obese.

As a result of lowering dietary intake from fat and increasing it substantially from carbohydrates, what happened to obesity statisticsDiabetes statistics?

Obesity became an epidemic.

In adults the prevalence of obesity [body mass index (BMI) ≥30 kg/m2] went from 10% in 1970-72 to 26% in 2009-11! In children, that rate doubled to 29% of children and adolescents being overweight or obese by 2007 and by 2011, obesity prevalence for boys was 15.1% and for girls was  8.0% in 5 to 17 year olds.

Based on waist circumference, 37% of adults and 13% of youth are currently considered abdominally obese.

Diabetes rates almost doubled.

In the 1970s, the rate of Type 2 Diabetes in women was 2.6% and 3.4 % in men, in the 1980s that number rose to 3.8% for women and 4.5% for men.  In the 1990s the rate was almost double what it was in 19704.7% for women and 7.5% for men.

Now get this: Type 2 Diabetes contributes to increased risk of heart disease.

So in an effort to reduce rates of heart disease by lowering fat intake and increasing carbohydrate intake, rates of Type 2 Diabetes doubled — which in turn, raised the risk of heart disease! Ironic.

If eating a high carbohydrate, low fat diet is associated with higher rates of obesity which in turn results in a higher incidence of Type 2 Diabetes, what is the option? Isn’t it also a problem to eat a low carbohydrate / high fat diet… isn’t a high fat diet bad for you?”.

This is the question that we will begin to answer in this article and conclude in the next one.


Are all fats the same? Is extra virgin olive oil in the same category as bacon? Or fish oil as lard?

The Health Canada guidelines recommend eating low fat dairy products, lean meat and using a “small amount — 2 to 3 tablespoons (30 to 45 mL ) of unsaturated fat each day. This includes oil used for cooking, salad dressings, margarine and mayonnaise“.

1. We are told to use a small amount of unsaturated fat per day; what is an unsaturated fat and are they all the same?

2. Is the fat in dairy products and meat “bad” for you?

I am going to answer the first question in this article and the second question in the next one.


1. What are the different type of fats.

There are two main classes of fats — saturated fats and unsaturated fats.

Unsaturated fat can be further classified as polyunsaturated fats and mono-unsaturated fats. Polyunsaturated fats include everything from omega-3 fats from fish oil to the fat found in omega-6 fats found in canola oil and corn oil. More about what makes it an ‘omega-3’ or ‘omega-g’ below. Omega-3 fats, especially the long chain ones from fish oil (e.g. DHA, EPA) are heart-healthy and are anti-inflammatory and have been found to be protective against heart disease. Refined seed oils that are high in omega-6 fats are pro-inflammatory.

Monounsaturated fats such as those found in avocado and nuts or cold-expressed from olive oil or avocado or nuts and seeds are considered by Health Canada and the writers of Canada’s Food Guide as the healthiest (and thus, preferred) kind of fat.

We’ve been told to eat a “low fat diet” but are all fats the same? Are omega-3 fats from fish to be lumped together with fat from bacon? And if we eat a diet low in saturated fat, will our “bad” cholesterol (LDL) go down?

Most people have heard that of the fats taken in from the diet, saturated fat is “bad” for you and mono-unsaturated fat and polyunsaturated fat is “good” for you.  Before we deal with whether this is true, let’s define what these are.

There are some basics that we need to cover, to ‘follow’ the discussion as to whether saturated fat in the diet results in high LDL cholesterol and high Triglycerides (TG). I’ll try to make this much less painful than it may have been when you first learned this.

  • fatty acids are molecules made up of a carbon backbone.  Think of it like a train with cars connected together.  Actually think of it more like “fuselage” of a plane (which will become clear as to why, below). The body is made up of carbons all in a row.
  • if there are no double bonds in the carbon chain, it is a saturated fatty acids because something can bond at every carbon along the carbon chain.  Think of those molecules that bond to a carbon as “wings” sticking off the fuselage.
  • if there is one double bond in the carbon chain, it is an unsaturated fatty acid. It is “unsaturated” because no other compound can bond where the double bond is. So it can have “wings” every where else along the carbon chain (which makes it unsaturated) but not at the place where the one double bond is.
  • if the carbon chain has more than one double bond, it is called a polyunsaturated  fatty acids (PUFAs).
  • there can be a double bonds off one of the carbons in the carbon backbone chain.
  • where the double bond off the carbon backbone is located determines whether it is an omega-3 polyunsaturated fatty acid or an omega-6 polyunsaturated fatty acid.
  • all omega-3 fats have their first double bond in the same place on the carbon chain (away from what is called the ‘carboxyl’ end).  All omega-3 fats have their first double bond starting at the 3rd carbon (away from what is called the ‘carboxyl end’).
  • all omega 6 fats have their first double bond starting at the 6th carbon (away from the carboxyl end)

That’s pretty well all the chemistry you need to know.

So we’ve heard that we should decrease our intake of all fat, especially saturated fat as it leads to high LDL cholesterol, high triglycerides (TG) but is that true?   2. Is the fat in dairy products and meat “bad” for you?

3. Is saturated fat in the diet the only source?

Spoiler alert!  

Our bodies not only make fat, they synthesize saturated fat!

We will cover the making of endogenous (“in the body”) saturated fat in Part 2, coming soon!

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Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


follow me at:

 https://twitter.com/joykiddieRD

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Weight Gain as a Hormone Imbalance not a Calorie Imbalance

scaleAs covered in an earlier article, weight gain is not caused simply by taking in more calories than you burn (the so-called “calorie-in / calorie-out” model).  Calories in and calories out are interdependent factors, so when calories are restricted the body actually slows its metabolism, lowering the energy it uses for vital bodily functions. Basal Energy Expenditure (BEE) can decrease by as much as 30-50% in order to spare calories!

On the opposite end, when too many calories are taken in by someone who is already overweight, the body will try to get rid of them by increasing its Basal Energy Expenditure, usually by speeding up respiration, increasing heart rate and breathing and generating more heat.

The body does this because its ‘set point’; the weight at which your body likes to be and will tend to stay with very little effort, is highly regulated. It really isn’t that easy to gain or lose weight if we haven’t already compromised this built-in homeostatic mechanism.

That is why trying to control calories doesn’t work for long term weight loss. When we restrict calories, and increase our exercise, our body responds by increasing hunger, initiating craving (especially for foods such as simple carbs that can be broken down quickly to glucose for your blood) and by decreasing the amount of energy it uses.

Have you ever skipped a meal or lowered your calories so much that you feel cold; even though the room is at an adequate temperature and you are dressed appropriately? You are shivering because your body is sparing calories it would normally use for heat generation.

Body Weight is Regulated by Hormones

Body weight is not really under our control as much as we’d like to believe.  It is a tightly regulated process that involves a variety hormones including leptin (a hormone that regulates fat stores by inhibiting hunger), ghrelin (a hormone that increase hunger when your stomach is empty) and insulin, which plays a very significant role in hunger, eating behavior and fat management.

To understand how significant a role insulin plays in weight regulation, let’s look at a situation where there is insufficient insulin. Type I diabetes results from the destruction of the insulin-producing pancreatic islet cells stemming from an autoimmune disorder. One of the hallmarks of this disease and it’s very low levels of insulin is severe weight loss. Type I diabetics need to take insulin injections to correct for the insulin deficiency but the more insulin that is taken, the more weight gain there is. As insulin levels go up, hunger is triggered and we feel the urge to eat.

Insulin is one of the major controllers of the body set point.

As mentioned, if we don’t take in sufficient calories, then our body decreases our Basal Energy Expenditure so that we end up maintaining our body weight in response to whatever the number of calories are that we take in.  The issue in weight gain is not how to reduce calories but how to reduce insulin.

Insulin as the Main Factor in Weight Gain

When we eat food, our body releases insulin in response to the rise in glucose in our blood, coming from the digested food. Insulin acts as a messenger to instruct the body’s cells to absorb glucose, in effect reducing blood glucose levels.

Insulin resistance is a condition in which the cells of the body become resistant to insulin and fail to respond normally to normal levels insulin, leading to higher blood sugar. The pancreas tries to compensate to this condition by producing more and more insulin.  As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal but when the pancreas can no longer produce enough insulin, the blood glucose levels begin to rise.

Initially, this added rise in blood glucose happens after meals (when glucose levels are already at their highest) and more insulin is needed – but eventually these higher levels of glucose are seen first thing in the morning when the person hasn’t eaten for 8 or 10 hours. When blood sugar rises abnormally above specific clinical levels, the person is diagnosed as having Type 2 diabetes. Insulin resistance is often called “pre-diabetes” because it precedes the development of Type 2 Diabetes.

Consistently high blood glucose levels along with insulin resistance lead to cells that are starved of glucose even though there is plenty of glucose in the blood. Since the cells aren’t getting any of the glucose even though it is there, it is not available to the cells because insulin is not binding it and taking it in. As a result, hunger signals are sent to the brain, leading to eating, even though the person has recently eaten.

As more and more glucose accumulates (both from the food being eaten and as you will see in a minute, through the making of glucose due to the effect of cortisol, another hormone) the high levels of glucose trigger the body to store the excess glucose as body fat.

The Effect of Stress on Weight Gain

Cortisol, the so-called stress hormone also plays a role in weight gain. Let’s look at another medical conditions to illustrate the effects of cortisol. In Cushing Syndrome, cortisol is over-produced by the body and weight gain results.  When we give people a synthetic form of cortisol as a medication (e.g. prednisone) they get something called Cushinoid Syndrome.  That is, they look like they have Cushing ’s disease. Not only do they gain weight, but there is a particular distribution of this weight gain called truncal obesity which means that fat is gained around the belly, rather than on the arms and legs.

In adrenal insufficiency (also known as Addison’s disease) which produces the opposite effect, the adrenal gland becomes damaged due an autoimmune condition and is unable to produce cortisol.  The hallmark of Addison’s disease is weight loss.

So what role does cortisol play in healthy individuals? Cortisol is released as a result of ordinary events such as waking up in the morning or exercising, but also is released in response to physiological and psychological stress.  Physiological stress might be an illness or injury and the release of cortisol services a needed function to make sure we have enough glucose to heal.

Under stressful conditions, cortisol also plays the role of providing the body with glucose by tapping into protein stores via gluconeogenesis in the liver. This energy can be helpful in a “fight or flight” type of stressor, such as when one is being chased by something however under constant levels of psychological stress, elevated cortisol over leads to higher levels of glucose being made from protein in the body the long term.  So in addition to glucose coming from the food we eat (exogenous sources), we now have the body making its own glucose (endogenous sources).  The combined exogenous glucose from good and the endogenous glucose triggered by cortisol, now leads to even higher blood sugar levels that without the long term stress.

With continually high levels of cortisol, the body will take fat that is stored as triglycerides in our liver and relocate them to visceral fat cells — those under the muscle, deep in the abdomen. Just like in Cushing’s syndrome, we now see truncal obesity triggered by stress, mediated by cortisol.

Weight Gain is due to Hormonal Triggers and not a Lack of Will-Power

Cortisol also directly influences appetite and cravings by binding to hypothalamus receptors in the brain, triggering us to eat and crave foods that are easily broken down to glucose.  Cortisol also indirectly influences appetite by modulating other hormones that stimulate appetite. Simple carbohydrates like bread, pasta, candy and pop are common foods that people reach for in response to these craving because they are easily broken down to simple sugars. So, it is actually the higher levels of cortisol that lead to increased appetite and in particular cravings for high-calorie foods, not simply a lack of will-power.

As you can see, we don’t really control our body weight any more than we control our heart rates.  To a large degree, body weight is regulated automatically under the influence of hormones; hormones that indicate to eat and indicate when we are satiated.  Hormones signal our bodies to increase energy expenditure and when calories are restricted, hormones will slow energy expenditure.

Why All Diets Work and often All Diets Fail

It doesn’t really matter which diet people follow, whether it is Atkins, South Beach, or the good old fashioned low fat, low calorie diet, all diets in the short term produce weight loss. Yes, some are healthier than others, but they all “work”.

One would hope that by continuing to eat according to what ever diet we’ve chosen and by exercising, that our body’s set point would reset at a lower level, but this doesn’t happen.

Insulin levels stay high, continuing to drive hunger and eating.

How does this affect weight loss?

A few months into our diet, regardless what diet we follow, weight loss begins to plateau.  As the plateau continues, people get discouraged, and think to themselves ‘if I’m not losing weight, then I may as well eat – fill in the blank’. This is either followed by an abandoning of the diet completely and a regaining of the weight previously lost (or more) or by a stubborn insistence to restrict calories and fat even further — leading to a downshifting of basal energy expenditure. It’s a vicious cycle.

But why does Body Weight Plateau in the First Place?

In response to weight loss, the body tries to return to its original set point.  First it slows metabolism to try and slow down weight loss – resulting in slowed weight loss and eventual plateauing.

The reason is because we’ve done nothing to lower insulin levels.

Think of set point like a ‘body weight thermostat’. With a thermostat, when the air is hot enough, the furnace turns off and when it is too cool, the thermostat turns the furnace on.  Regardless what kind of diet a person follows, there will be weight loss effects in the short term, but eventually, even with continued compliance, body weight plateaus and in time, the person begins to regain the weight.

What about exercise?

Surely exercise will help us lose weight, right?

Basal energy expenditure which is the amount of energy we use at rest is estimated to be approximately 12-15 calories per pound.  For someone confined to complete bed-rest, caloric needs are calculated as 1.2 times Basal energy expenditure (BEE).

To visualize the effect exercise has on calorie loss, let’s take a 140 pound person as an example, whose basal caloric needs are 2200 – 2500 calories per day. Say they start exercising.  They start walking at a moderate pace (2 miles/hour) for 45 minutes every day, and burn roughly 104 calories.  Let’s look at that in terms of basal energy expenditurethat is only 4% of the BEE.  Okay, so say the person starts working out at a more vigorous pace, calorie burning will go up, right?  But how much?  6% of BEE?  8% of BEE? That’s about it.

The bottom line is, the vast majority of calories you take it; about 95% of caloric intake is used to heat the body and other metabolic processes, including keeping your heart beating, breathing, digestion, brain function, liver and kidney function, etc.

Set point is a tightly regulated mechanism, like a thermostat.  When we burn more calories through exercise two things happen.  Studies show that people actually end up decreasing their activity outside of the period of exercise and the other is they increase their caloric intake in response to exercise. That’s where the phrase “working up an appetite” comes from.

The reason exercise is not that effective for weight loss is because of metabolic compensation.  We understand this intuitively though, don’t we? When know when we cut calories, restrict certain foods and increase our exercise that our body responds by being more hungry and increasing cravings. We try to take extreme measures only to find that we don’t really have a chance at making the weight loss last long term.

Don’t misunderstand; exercise is good for you.  There are many benefits to regular exercise such as improved cardiovascular function, increased strength and flexibility, and lowering stress which will lower cortisol but weight loss is not one of the significant benefits of exercise.

So if restricting calories causes are energy usage to slow and results in us being more sedentary outside of the times we exercise or eating more in response to exercise, how do we lose weight and keep it off?

To keep weight off long term, we need to address the underlying hormonal trigger to hunger and appetite; mainly insulin. To lower weight and keep it off, we need to lower our insulin level.

There are two aspects to lowering insulin levels (1) the foods we eat and (2) when we eat and this will be the topic of our next blog.

scale

 

 

 

 

 

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Obesity Rates in Canada and Changes to Canada’s Food Guide

Introduction: Many people look to Canada’s Food Guide (CFG) as the “measuring stick” as to whether they are eating a healthy diet, but did you know that over the years, CFG has changed dramatically? Canada’s first food guide, the Official Food Rules, was introduced to the public in July 1942. This guide acknowledged wartime food rationing, while endeavoring to prevent nutritional deficiencies and to improve the health of Canadians. Over the years the names of the food groups, the serving sizes and numbers of servings has changed.  Serving sizes are now given in ranges; and one has to wonder if these changes have resulted in “over-nutrition”.

Changes in Canada’s obesity rates seems to parallel the changes in Canada’s Food Guide which is the topic of this blog.


Canada’s Food Rules – 1949

The post-WWII “Canada’s Food Rules” of 1949 emphasized people taking in sufficient nutrients to prevent nutritional deficiency as well as to avoid excess, by stressing that “more is not necessarily better”.

Adult guidelines promoted;

canadas_food_rules_19492 cups or more of full fat milk

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry or dried beans, eggs (3x / week), cheese (3x / week)

use liver frequently


Canada’s Food Guide – 1961

In the 1961 version the language softened; with “Guide” replacing “Rules” in the title. Canada’s Food Guide now sought to emphasize its flexibility and wide-ranging application for healthy eating, recognizing that many different dietary patterns could satisfy nutrient needs.

Adult guidelines promoted;

1961-eng1 1/2 cups or more of full fat milk (decreased by ½ cup)

1 serving of citrus or tomatoes daily & 1 other fruit

2 serving potatoes plus 2 servings other vegetables (preferably yellow or green and frequently raw)

4 slices of bread with butter and 1 serving whole grain cereal

one serving meat, fish or poultry, eggs (3x / week), cheese (3x / week) or dried beans

use liver frequently

Reference: Nutrition Division, National Department of Health and Welfare (1961). Rules out – guide in. Canadian Nutrition Notes, 17(7):49-50 (cited in Health and Welfare Canada. Action towards healthy eating: technical report. 1990).


Canada’s Food Guide – 1977

In 1977 Canada’s Food Guide underwent a dramatic revision. There were now four food groups, instead of five, as fruits and vegetables were combined since their nutrient content overlapped and the name of those groups changed, too.

The Milk group became Milk and Milk Products, to highlight the inclusion of other dairy foods, Meat and Alternates replaced Meat and Fish allowing for vegetarian choices — but also resulting in the inclusion of things like peanut butter in this category, rather than categorized in the ‘fat’ category as occurs in other systems, such as the Food Exchanges.

Most significantly, serving ranges were added.

The big focus was on more carbs and less fats (regardless of what the sources of those fats were) — there was no differentiation between lard and olive oil. There was a shift to using low fat dairy products and the beginning of generations of “fat phobic” Canadians began.  “Low Fat” products became all the rage.

cfg_history_1977_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ – 1 cup* nuts or seeds).

In 1977, there was introduction of a concept of “energy balance”; balancing energy intake with energy output (“calories in / calories out” model) which makes the assumption that basal metabolic rates stays the same.

With the goal of reducing diet-related chronic diseases (such as heart disease and high blood pressure), Canada’s Food Guide encouraged Canadians to reduce salt and fat, without distinguishing between sources of fats. In the process, the quantity of all kinds of fat, including healthy monounsaturated fats such as olive oil and nut and seed oil were all reduced.  Canada’s Food Guide encouraged Canadians to eat plenty of fruits and vegetables without distinguishing between high fiber, non-starchy vegetables and high carbohydrate starchy vegetables. More on that below.

Before 1977, the obesity rate [measured as Body Mass Index (BMI) ≥ 30 kg / m2] of Canadian adults was <10%.  Keep that number in mind. It changes considerably over the years as Canada’s Food Guide recommendations changed.


A report submitted to Health Canada in 1977 by the Committee on Diet and Cardiovascular Disease advised the government to take action to prevent diet-related chronic diseases such as heart disease and high blood pressure, so the emphasis in the revised 1982 Canada’s Food Guide was towards even lower fat products.

Lower fat in products often meant more sugar (as fructose or high fructose corn syrup) being added to products such as yogourt, to help make up for the missing taste. Portions of nuts and seeds which contain heart-healthy monounsaturated fats were reduced in the ongoing push to lower all fat in the diet.

There was a continued shift towards carbs as the main source of calories; not only from Breads & Cereals, but from Fruit & Vegetables too — and in this category, there was no distinction between starchy vegetables (such as potatoes, peas, corn, squash and yams) and non-starchy vegetables, such as salad greens or asparagus.  As a result, a serving of sweet potato was categorized no differently than a serving of salad greens.

Furthermore, a serving of fruit juice was considered equivalent to a serving of fruit; with no concern for the fact that there was no fiber in the juice and significantly more carbohydrates per serving.  Carbs were perceived as “good” and fat was promoted as “bad”.  As a result of these changes, under this new Canada’s Food Guide, one could have 3 glasses of juiceone serving of potato and a tiny salad and “meet” the guidelines.

 Canada’s Food Guide – 1982

Adult guidelines promoted;

cfg_history_1982_two_small2 servings (skim, 2%, whole) milk, buttermilk or yogourt (1 serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

4-5 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

3-5 servings of Bread and Cereal

2 servings  Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or 1 cup dried cooked legumes or ½ cup* nuts or seeds).

Reference: Ballantyne, R.M., Bush, M.B. (1980). An evaluation of Canada’s food guide and handbook. Nutrition Quarterly, 4(1):1-4.


Canada’s Food Guide – 1992

In 1992, Canada’s Food Guide became Canada’s Food Guide to Healthy Eating.

A new “total diet approach” aimed to meet both energy (calories) and nutrient requirements, resulted in large ranges in the number of servings in the four food groups.

To meet higher energy needs, the Guide encouraged selection of more servings from the Grain Products and Vegetables and Fruit groups – resulting in an even higher percentage of carbohydrates in the diet.

Adult guidelines servings changed as follows:

cfg_history_1992_two_small3-5   5-12 servings of Bread and Cereal

4-5   5-10 servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

2   2-4 servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2   2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)

Grain Products were now 1st on list (5-12 servings!); reflecting the shift that most of calories (45-65% of calories) were to come from carbs.

Vegetables and Fruit were put 2nd on the list (5-10 servings) and could still be chosen as all carbs (potato, yams, other starchy vegetables, fruit, fruit juice) and along with this, there was a continued decrease in calories from fat (e.g. nut butters went from ½ cup – 1 cup in 1977 to ½ cup 1982 to 2 Tbsp. in 1992)

Also in this Guide, cheese was categorized with milk and yogourt – even though other ways of accounting for food such as the Diabetic Exchanges, classify cheese with Meat and Alternates (and nut butters with fat).


In 2005, there were even more changes to Canada’s Food Guide to Healthy Eating.  This is the Guide currently in use in Canada.

The numbers of servings were broken down based on stage of life and gender, but continuing the emphasis on high carbohydrate, low fat.  There were different number of servings per day for children aged 2-3, aged 4-8, aged 9-13, adolescent girls (aged 14-18), adolescent boys (aged 14-18), men (until aged 50), women (until aged 50) and then men over 50 and women over 50.

While Vegetables and Fruit were now put 1st instead of Grain Products, these could still be chosen as mostly carbs (potato, yams, other starchy vegetables, fruit, fruit juice), so with Grain Products put 2nd, carbs still formed the bulk of daily calories.


Canada’s Food Guide – 2005

Adult guidelines promoted (adults aged 19-50 years):

CFG 20055-10   7-8 (women) 8-10 (men) servings fruit & vegetables (at least 2 vegetables) – cooked, raw or fruit juices, include yellow or green or green leafy vegetables

5-12   6-7 (women) 8 (men) servings of Grain Products

2-4   2 (women and men) servings (skim, 2%, whole) milk, buttermilk or yogourt (serving = 1 cup milk, ¾ cup yogourt, 1 ½ oz cheese)

2-3 servings Meat and Alternates – (1 serving = 2-3 oz lean cooked meat, fish or poultry or 2 eggs or ½ – 1 cup cooked legumes or 2 Tbsp. peanut butter)

Recommendations include:

Vegetables and Fruit

go for orange vegetables such as carrots, sweet potatoes* and winter squash*

*Note: starchy vegetables such as sweet potato and winter squash contain the SAME number of carbohydrates per serving as a serving of Breads and Cereals i.e. 15 g carbohydrate per ½ cup serving compared with non-starchy vegetables such as asparagus, broccoli and salad greens.

Under this Guide, Vegetables and Fruit can contribute 105 g – 150 g carbs per day (400 – 600 calories per day) if chosen as starchy vegetables and fruit / fruit juice.

Milk and Alternates

The Guide recommends: “Drink skim, 1% or 2% milk each day” which overlooks the satiety (feeling fuller) effect of higher fat dairy.

“select lower fat milk alternates” – fails to look a the fact that loads of sugar as flavouring replaces the fat, contributing the equivalent of 2 – 4 servings of carbs per 3/4 cup serving (where a serving of carbs as per the Food Exchanges is considered 15 g carbohydrate per serving)

Oils and Fats

The Guide recommends: “include a small amount (2-3 Tbsp.) of unsaturated fat each day.  This includes oil for cooking, salad dressing, margarine and mayonnaise. Use vegetable oils such as canola and soybean” resulting in the decrease of healthy-monounsaturated fats such as olive oil, nuts and seeds.

Children

The Guide recommends to “serve small nutritious meals and snacks daily

Three meals AND a few snacks?

What effect have these dietary recommendations had on obesity statistics?

Let’s look at children;

  • In 1978, only 15% of children and adolescents were overweight or obese.
  • By 2007, that rate doubled to 29% of children and adolescents being overweight or obese.
  • By 2011, obesity prevalence alone for boys was 15.1% and for girls was at 8.0% in 5 to 17 year olds.

What about adults?

  • The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased from 10% in 1970-72 to 26% in 2009-11
  • Based on waist circumference 37% of adults and 13% of youth are abdominally obese.
  • Looking at these numbers slightly differently, as of 2013, there were approximately 7 million obese adults and 600 000 obese school-aged children in Canada

One has to wonder whether this dramatic increase in obesity and overweight after 1977 is correlated to Canada’s Food Guide shift to lower fat, higher carbohydrate diets.

In my  Dietetic practice, I give clients a choice of meal plan patterns because I don’t believe three meals and three snacks per day with 45-65% of calories as carbohydrate is the best way for people to address the matter of their excess weight.

For clients that come to me insulin resistant and/or overweight, I explain based on the literature why I recommend a meal plan pattern based on full meals without snacks with most of the calories coming from heart healthy satiety-offering monounsaturated fats. When clients are able to eat until they are satisfied without feeling hungry between meals and without feeling deprived, they are able to lose weight naturally and relatively easily.

Of course if clients want a meal plan based on the traditional 3 meals and 3 snack meal pattern I provide that for them using current recommendations.  There is no question that both ways, people can lose weight and lower their blood sugars, but my interest as a Dietitian is not only to see people’s weight and blood sugar and cholesterol come down, but to also see them feeling good and being happy with the process.

If you would like more information on the services I offer, please click on the Contact Us tab, above to send me a note.


Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Canada’s Food Guide – an Epidemiological Experiment Gone Terribly Wrong?

In 1972 the prevalence of obesity (BMI > 30) in those over 19 years old in Canada was only 10% but by 2011, it was 26%. In 1972 <8% of men were obese whereas obesity rates have TRIPLED in men since then and also increased for women. In this blog I tackle how changes in the recommendations of Canada's Food Guide has paralleled these huge increases in obesity statistics.

Health Canada released a statement this past Tuesday (May 19, 2015) implying they may change Canada’s Food Guide recommendations. Their statement came just a week after a Canadian Medical Association Journal released a report a week earlier (May 11, 2015) summarizing some of the criticisms of the Guide made by healthcare professionals who presented at the Canadian Obesity Summit in Toronto at the beginning of May.  One of the criticism included Health Canada’s current endorsement of 100% juice as equivalent to a serving of fruit.

Canada’s Food Guide (officially called Eating Well with Canada’s Food Guide) recommends that Canadian adults consume up to 10 servings of fruit and vegetables a day (depending on age and gender) and with a half-cup of juice counting as a single serving, it’s easy to see how a person might drink a few cups of fruit juice a day in order to try and meet that requirement.  The problem arises that even a single glass of orange juice can put you over the daily sugar limit recommended by the World Health Organization (WHO).

In March, the World Health Organization (WHO) released a report entitled Guideline: Sugars intake for adult and children where it concluded that the world was consuming too much sugar and recommended that people cut their intake of sugar to the equivalent of just six to 12 teaspoons per day.

Many popular brands of 100% orange and apple juice sold in Canada contain as much as five teaspoons of sugar per serving so it’s easy to see that if the public is trying to meet their 7-10 servings of fruit and vegetables by drinking juice, they will be way over the WHO’s daily sugar limit.

A study from the UK that was just published 2 weeks ago in the European journal Diabetologia linked daily consumption of sweetened drinks including so-called “healthy” beverages like sweetened milk and fruit juice with increased diabetes risk. The study found that for each 5% increase of a person’s total energy intake provided by sweet drinks (even so-called “healthy ones” like chocolate milk and 100% juice) that the risk of developing Type 2 diabetes could rise by 18 %. The study also found that by replacing one sweetened drink with water or unsweetened tea or coffee per day could help cut the risk of developing diabetes by as much as 25%.

This most recent statement from the director of the Office of Nutrition Policy and Promotion Hasan Hutchinson said the department is currently “reviewing the evidence base for its current guidance” to Canadians and that “depending on the conclusions of the scientific review, guidance for consumption (quantity and frequency) of various foods, including juice, could be updated in the future”. In my opinion, consumption of 100% fruit juice as equivalent to a serving of Vegetables and Fruit is not the only aspect of Canada’s Food Guide that Health Canada needs to re-evaluate.

Shift to a Carbohydrate-based Diet; how has that worked out?

Prior to 1977, Canada’s Food Guide recommended no more than 5 servings of bread or cereal per day for adults and now recommends 6-7 servings per day of Grain Products for women and up to 8 servings of Grain Products per day for men. In 1961, Canada’s Food Guide recommended only 1 serving of citrus fruit (as fruit) or a serving of tomatoes daily & only one other fruit.  Now adults can have any of the recommended 7-10 servings of Vegetables and Fruit per day as fruit (or juice). Even as actual servings of fruit, current recommendations can be chosen as 4-5 times the amount of fruit as in in 1961.

Since 1977 and in ever increasing amounts, Health Canada has shifted their recommendations away from healthy fats and low carbohydrate diets, towards diets where carbohydrates form the main source of calories.  Current recommendations are for 45-65% of calories to come from carbohydrate and only 20- 30% of calories from fat.  Our society has become “fat phobic” thinking all sources of fat are “bad”. People drink skim or 1% milk and eat 0% yogourt and low fat cheese; all the while making sure to have “enough’ carbohydrates; 6-8 servings of Grains Products (including bread, pasta and rice). Hidden as Vegetables are even more carbohydrates as the 7-10 servings of Vegetables and Fruit which are recommended for an adult to eat makes no distinction between starchy vegetables (like potatoes, yams, peas and corn) and non-starchy vegetables (like salad greens and asparagus or broccoli). People can literally eat all their Vegetable and Fruit servings as carbohydrate laden starchy vegetables and fruit and “meet” Canada’s Food Guide!

Canadians are encouraged to fill themselves up on toast or cereal for breakfast, sandwiches or rice for lunch and pasta or pizza (with “healthy toppings”) for supper; all in an effort to “meet” Canada’s Food Guide.

At the same time, people have been conditioned to avoid fats because they believe that fat is “bad”; while making no distinction between healthy fats from avocado, nuts, seeds and fatty fish and fats from chemically cured bacon and nitrite- laden sausage.

What Has Happened to Canada’s Obesity Rates since 1977?

In ever increasing amounts, Health Canada has recommended that we avoid fat and get 1/2 to 2/3 of our calories from carbohydrates? How has Canada’s obesity rate changed since then?

In 1978, only 15% of children and adolescents were overweight or obese.

By 2007, 29% of children and adolescents were overweight or obese.

By 2011, just the obesity prevalence for boys was 15.1% and for girls was 8.0% in 5- to 17 year olds.

What about adults?

The prevalence of obesity [body mass index (BMI) ≥30 kg/m2] in Canadian adults increased two and a half times; from 10% in 1970-72 to 26% in 2009-11.

In 1970-72 7.6% of men and 11.7% of women were considered obese.

In 2013, 20.1% of men and 17.4% of women were considered obese.

And looking at waist circumference rather than BMI, 37% of adults and 13% of youth are currently considered abdominally obese.

So how has Health Canada’s recommendations of a high carbohydrate low fat diet been working out?

Certainly there must be a better way?

There is.

More in my next blog.

In the meantime, if you would like to learn a better way to think about food why not contact me?

I can help you begin to tackle overweight or obesity in a way that encourages eating healthy fat and which are supported by current research literature.

I can also help you learn which sources of carbohydrate provide the best nutrition to meet your daily recommended nutrient intake for vitamins and minerals as well as how to eat in a way that can begin to tackle one of the main issues associated with being overweight; that of insulin resistance.

Click on the “Contact Us” tab above, to send me a note.


References

Canadian Medical Association Journal, Early Releases (May 11, 2015), Food Guide Under Fire at Obesity Summit, www.cmaj.ca/site/earlyreleases/11may15_food-guide-under-fire-at-obesity-summit.xhtml

http://www.cbc.ca/news/health/canada-food-guide-s-listing-of-juice-as-a-fruit-serving-called-bananas-1.3080658

http://www.ctvnews.ca/health/will-fruit-juice-be-cut-from-canada-s-food-guide-1.2380960

Janssen I, The Public Health Burden of Obesity in Canada, Canadian Journal of Diabetes, 37 (2013), pg. 90-96

Nutrition Division, National Department of Health and Welfare (1961). Rules out – guide in. Canadian Nutrition Notes, 17(7):49-50 (cited in Health and Welfare Canada. Action towards healthy eating: technical report. 1990).

O’Connor, L, Imamura F, Lentjes M et al, Prospective associations and population impact of sweet beverage intake and type 2 diabetes, and effects of substitutions with alternative beverages, Diabetologia May 6, 2015 [Epub ahead of print]

Statistics Canada, Overweight and obese adults (self-reported) 2009, http://www.statcan.gc.ca/pub/82-625-x/2010002/article/11255-eng.htm

World Health Organization, Guideline: Sugars intake for adult and children, March 2015, http://who.int/nutrition/publications/guidelines/sugars_intake/en/

Note: Everyone's results following a LCHF lifestyle will differ as there is no one-size-fits-all approach and everybody's nutritional needs and health status is different. If you want to adopt this kind of lifestyle, please discuss it with your doctor, first.

Copyright ©2015 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Why do we Gain Weight – the Myth of “Calories in, Calories out”

People often assume that the answer to the question why do we gain weight is obvious and it is because people eat more calories than they burn; the old “calorie in, calorie out” paradigm. That is, calories not used in some form of exercise are converted to fat and stored. If we assume that the cause of weight gain is that simple, then the solution must be equally simple; eat less and exercise more, right? But is it?

People often assume that the answer to the question why do we gain weight is obvious and it is because people eat more calories than they burn; the old “calorie in, calorie out” paradigm.  That is, calories not used in some form of exercise are converted to fat and stored.  If we assume that the cause of weight gain is that simple, then the solution must be equally simple; eat less and exercise more, right? But is it?

Many Physicians and Dietitians continue to hold to this “calorie in, calorie out” model and to counsel their patients that in order to lose the stored fat, they need to eat less and exercise more.  If it is really that simple, then why are 4.7 million adults in Canada classified as obese and more than 40% of men and 27% of women classified as overweight? If it is that simple, why do obesity statistics continuing to rise? Because it isn’t that simple.

There is an underlying assumption that “calories in” and “calories out” are two independent events.  That is, if you reduce “calories in”, “calories out” is unaffected. The difficulty lies in that the body decides where it is going to “spend” the calories taken in. Let’s say we take in 2000 calories; some will be used for the energy we need during a 24-hour period by our body during resting conditions (Basal Energy Expenditure) and some will be used to synthesize muscle, bone or other proteins.  “Calories out” is not just exercise.

Another underlying assumption is that all calories are created equal. But are they? First what is a calorie?

A calorie is the amount of heat that is released when certain foods are burned in a laboratory.  It doesn’t matter if the food is protein, fat or carbohydrate, if they have 100 calories then 100 calories of heat is released when they are burned. So in the “calorie in, calorie out” model it really doesn’t matter what we eat whether it is broccoli or butter, in the end it only matters how many calories they add up to.  Period.

If we start with the assumption that “calories in” are independent of “calories out” then the only thing that really matters is how many calories we take in, not from what sources. In this model, since all food is burned and a certain amount of calories are released, then we arrive at the conclusion that weight gain is simply a matter of comparing what goes in (energy) to what goes out (energy expenditure).  In this simplistic view, weight gain is caused by having too many calories (energy) compared to too little exercise (energy expenditure).  But it is not that simple.

Some of the energy expenditure will be for building tissue, staying warm, cognitive function and our bodies determine whether “calories in” go to those involuntary functions over voluntary exercise Looking at weight loss in terms of the “calorie in, calorie out” model fails to take into account that the body will slow its metabolism in response to reduced calories, because it needs to use those calories for vital functions so restricting calories doesn’t necessarily translate to weight loss.

Furthermore, assuming that all foods can be boiled down to how many calories they contain fails to take into consideration that the composition of different types of foods actually increases or decreases hunger and thus eating when and what and how much we eat. The assumption by many health care professionals has been that obese people are overweight because their metabolism has slowed and that keeps them from burning off the calories they take in.

To explain this in terms of the “calories in calories out” model, say a slim person takes in 2000 calories and has a Total Energy Expenditure (TEE) [the amount of calories they burn per day] of 2000 calories, which means they don’t gain or lose weight. An obese person will take in the same 2000 calories, but assuming their TEE is lower, say 1500 calories, 500 calories are store as fat and they gain a pound. But is that in fact so?

A recent study however has disproven this.

When measured in the laboratory, obese people had a Total Energy Expenditure (TEE) of 3244 calories compared to lean people who had a TEE of 2404 calories. That is, when excess calories are eaten in someone who is already obese, the body will actually increase its Basal Energy Expenditure (BEE) to try and get rid of those calories.

So why are obese people obese?

Shouldn’t this increase in Total Energy Expenditure over time caused them to burn off those calories and become lean again? Actually, body weight, like other functions in our body is a closely regulated system and we have so something called a “Set Point” which acts to regulate it. When too many calories are taken in, the body tries to get rid of them and when too few calories are taken in, the body tries to conserve them. The body does this to maintain its ‘set point’. So if we are overweight, the body will adjust its processes to maintain that set point. More on that below. It is not about how many calories we take in but what changes the Set Point.

People also make the assumption that how much we eat (“calories in”) is voluntary; that is we can choose to eat or not eat, but there are a number of hormones such as leptin, ghrelin, cholecystokinin, and peptin YY that tell our body when we are hungry and we are not. Hunger and satiety (feeling full) are under hormonal control and as such, when we eat (“calories in”) is not voluntary.

People also assume that ‘Calories Out’ is voluntary; that we control how much exercise we do and assuming that our basal energy expenditure is stable and unchanging over time, we ignore it.  But it is not. This mistaken belief that the only variable that changes is the energy expended in voluntary exercise and that this consumes a major proportion of our calories leads to the conclusion that “diet” and “exercise” are equal partners in weight management and they aren’t.

The fact is, most of our Total Energy Expenditure is used for generation of body heat and other metabolic processes (called Basal Energy Expenditure). Furthermore, Basal Energy Expenditure is not stable and can increase or decrease by as much as 50%. This up-regulation and down-regulation of our body processes contributes way more to weight loss or gain than exercise does. But that is not what we’ve been told.  We have believed that if we just exercise more and eat less we will lose weight. Let’s look at this a little more closely.

What happens to our body if we suddenly restrict caloric intake? According to “calories in calories out” model, a reduction in calories will result in Total Energy Expenditure (TEE) using fat for energy and the person would lose weight.  Sounds great except that is not what happens.

In fact, Total Energy Expenditure drops substantially – by as much as 30-50%.  People complain of being unable to stay warm even with plenty of clothing and that is because calories are spared in heating the body. Heart rate and blood pressure drop to conserve energy (calories).  People even find it difficult to concentrate because the brain is very metabolically active and restricting calories suddenly turns that down. Calories are needed to move, so in sudden calorie restriction people feel weak during physical activity. In other words, metabolism slows.

Why does the body do this? It’s survival.

Consider a person normally eating 3000 calories a day suddenly starts eating 2000 calories a day.  If they were to continue to burn 3000 calories daily, they would soon deplete all their fat stores, then their protein stores and then they would die. The body tightly regulates body weight and compensates for this sudden decrease in calories by saving calories from its Total Energy Expenditure.  Instead of burning fat in storage, the body reduces its caloric expenditure on body functions to 2000 calories a day and restores balance.

The “calorie in calorie out” model does not factor in that basal energy expenditure is not stable.  It ignores that restricting calories results in down-regulation in Total Energy Expenditure. That is, “calories in” and “calories out” are not independent.

The “calorie in calorie out” model of weight gain also ignores that hunger, eating and fat storage are regulated by numerous hormones. Leptin (a hormone correlated to the amount of body fat) is one such mechanism, adiponectin (a hormone supressed in obese people) may be another mechanism and there are others being researched.  It is also believed that cortisol, the stress hormone may play a role.  But there is one well-known hormone that plays a very significant role in hunger, eating behavior and fat management and that is insulin. Insulin’s effect will be covered in detail in future blogs. A little ‘teaser’; we as health care practitioners have been focussing on blood glucose while overlooking insulin, which regulates it.

So in summary,

  1. “calories in” and “calories out” are not independent, but one affects the other.
  2. “Calories in” is not only under voluntary control (what and how much we choose to eat) but several hormone play a significant role in terms of hunger and fat storage.
  3. “Calories out” is not only controlled voluntarily through exercise but also involuntarily by up-regulating and down-regulating basal metabolic expenditure (tissue synthesis, heat generation, etc).
  4. Fat storage is not simply a result of having more “calories in” than “calories out” burned as exercise.

So what causes us to gain weight? This will be the topic of future blogs.

REFERENCES

DeLany J P, Kelley D E, Hames K C et al, High energy expenditure masks low physical activity in obesity, International Journal of Obesity 37, 1006-1011 (July 2013)

Fung, Jason, Intensive Dietary Management, The Aeteology of Obesity, August 2013

Health Canada, Overweight and Obese Adults (2102), http://www.statcan.gc.ca/pub/82-625-x/2013001/article/11840-eng.htm

 

Copyright ©2015 BetterByDesign Nutrition Ltd.  LEGAL NOTICE: The contents of this website, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without regular monitoring by a Registered Dietitian and with the knowledge of your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing something you have read in our content. 

Staying properly hydrated (getting enough water)

How much water should people drink each day? Is it true that we need 8 glasses per day, and if so, how big would those ‘glasses’ have to be? Actually, your water needs depend on many factors, including your health, how active you are and the climate you live in.

Why water is important

Water is your body’s main component and makes up about 60 % of your body weight. Every system in your body depends on water; for example, water flushes toxins out of vital organs such as your kidneys and liver, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues. A lack of water can lead to dehydration; a condition that occurs when you don’t have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired. Severe dehydration can be significantly more serious; resulting in hospitalization and in some cases, death.

How much water do you need?

Every day, you lose water as you exhale, perspire, and of course, pass urine and have bowel movements. For your body to function properly, you must replenish lost water by consuming beverages and foods that contain water. How much water does the average, healthy adult living in a temperate climate such as southern Canada or the northern USA, need?  The Institute of Medicine in the United States has determined that an adequate intake (AI) for adult men is roughly 3 liters (about 13 cups) of total beverages a day (not just water). The AI for women is 2.2 liters (about 9 cups) of total beverages a day.

What about the advice to drink eight glasses a day?

Everyone has heard the advice, “drink eight 8-ounce glasses of water a day.” That’s about 1.9 liters, which isn’t that different from the Institute of Medicine recommendations. Just remember, it doesn’t have to be just water; all fluids count (except caffeinated ones, which increase urine output and thus, dehydrate you).

Factors that influence your water needs

You may need to modify your total fluid intake depending on how active you are, the climate you live in and how hot it is out, and your health status.

Exercise; If you exercise or engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. An extra 400 to 600 milliliters (about 1.5 to 2.5 cups) of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour (for example, running a marathon) requires more fluid intake. How much additional fluid you need depends on how much you sweat during exercise, and the duration and type of exercise. During long bouts of intense exercise, it’s best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be life-threatening. Also, continue to replace fluids after you’re finished exercising.

Environment; Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Further, altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves.

Illnesses or health conditions; When you have fever, vomiting or diarrhea, your body loses additional fluids. In these cases, you should drink more water and sometimes it is helpful to drink oral rehydration solutions, such as Gatorade or Powerade. Also, you may need increased fluid intake if you develop certain conditions, including bladder infections or urinary tract stones. On the other hand, some conditions such as heart failure and some types of kidney, liver and adrenal diseases may impair excretion of water and even require that you limit your fluid intake.

Pregnancy or breast-feeding; Women who are expecting or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink 2.3 liters (about 10 cups) of fluids daily and women who breast-feed consume 3.1 liters (about 13 cups) of fluids a day.

Beyond the tap: Other sources of water

Although it’s a great idea to keep water within reach at all times, you don’t need to rely only on what you drink to meet your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake. For example, many fruits and vegetables, such as watermelon and tomatoes, are 90 % or more water by weight.

In addition, beverages such as milk and juice are composed mostly of water. Remember though, while beer, wine and caffeinated beverages such as coffee, tea or cola and root beer contribute to fluid intake, these are best not be a major portion of your daily total fluid intake, as they increase fluid loss. Water really is your best bet because it’s calorie-free, inexpensive and readily available.

Staying properly hydrated

Generally if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or light yellow urine a day, your fluid intake is probably adequate. If you’re concerned about your fluid intake or have health issues, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that’s right for you.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. It’s also a good idea to:

• Drink a glass of water or other calorie-free or low-calorie beverage with each meal and between each meal.

• Drink water before, during and after exercise.

Is it possible to drink too much water?

Although uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia. Endurance athletes, such as marathon runners, who drink large amounts of water, are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who eat an average North American diet.

 

What is “high blood sugar”?

What is High Blood Sugar?

Glucose is the sugar that is found in your blood and comes from two sources (1) the food you eat and (2) your body making it in the liver or breaking it down from glycogen stored in your muscles. Your body needs to have glucose in the blood as a source of energy for your cells, but the glucose needs to be at specific levels. When the glucose level is higher than normal, this condition is known as “hyperglycemia” or “high blood sugar”. Insulin is a hormone made by the pancreas that helps move glucose from digested food into your cells and the pancreas releases insulin into the blood, based upon the blood sugar level.

Common Symptoms
Hyperglycemia doesn’t cause symptoms until glucose values are much higher than normal for a long time (>11 mmol/L) which is why diabetes is called a silent disease. It’s important to have your blood sugar levels checked by your doctor, especially if you are at risk. Watch for:

  • Frequent urination
  • Increased thirst
  • Blurred vision
  • Fatigue
  • Headache

Potential Causes
Sometimes, the body stops making insulin (as in type 1 / juvenile diabetes). Other times, the insulin does not work properly (as in “insulin resistance” or type 2 diabetes). In insulin resistance or in those with diabetes, glucose does not enter the cells properly, creating high blood sugar levels.

HOW CAN BETTERBYDESIGN NUTRITION CAN HELP?

Registered Dietitian

Our Registered Dietitian provides BetterByDesign Nutrition’s clients with the necessary tools to make healthy food choices and supports dietary changes in a variety of clinical conditions. BetterByDesign Nutrition’s experienced Registered Dietitian would be glad to help support the lifestyle changes you are seeking. For more information, or to set up an appointment, please click on the “Contact Us” tab, above.

Role of Green Tea Powder (Matcha) in Weight and Abdominal Fat Loss

Based on a meta-analysis of studies, it has been found that people can lose ~ 3 pounds in a 12 week period (making no other dietary or exercise changes) by consuming 1 – 4 tsp of green tea (matcha) powder per day. The effect of green tea catechins contained in matcha powder on body fat composition is great even when weight loss is small (i.e. ~5 lbs in 12 weeks), Total amount of abdominal fat decreases 25x more with green tea catechin consumption & the fat just below the skin of the abdomen decreases 8x more than when green tea catechins are not consumed !


matcha – green tea powder

UPDATE: 

(April 25, 2017) Be sure get the recipe for a Low Carb High Healthy Fat Matcha Smoothie here: https://www.lchf-rd.com/2017/04/24/low-carb-green-tea-matcha-smoothie-role-in-weight-and-abdominal-fat-loss/.

Less than 3 gm of carbohydrate at all the health benefits of Matcha!

 

 


Introduction

Recent estimates indicate that about 1/3 of the adult population in the US is obese [Centers for Disease Control and Prevention, 2009] and while 2011 estimates in Canada indicate that approximately 1/5 of Canadians adults are classified as obese based on self-reported height and weight [Statistics Canada], studies have found that obesity rates in self-reported weight is ~7.4% higher when based on measured height and weight [Shields et al].  Adjusting for this under self-reporting of weight, > 1/4 (25.6%) of the adult population in Canada would be considered obese.  Recent literature suggests that obesity and the related diseases of “metabolic syndrome” associated with obesity are not just a North American problem either, but a global health problem [Popkin].Although there are many genetic and environmental factors that may predispose people to weight gain, the main cause of overweight and obesity is believed to be an imbalance between dietary intake and energy expenditure (i.e. calories in > calories out).  Excess fat mass develops over time from a very small positive energy imbalance i.e. just taking in slightly more calories than needed.  In general, average weight gain per year is small; approximately 1 pound per year across all race, economic, and sex groups [Brown].There are many strategies used to address weight gain, including;-         

Dietary approaches; which usually focus on decreasing caloric intake through a variety of means and while some people go on self-chosen “diets” that are bizarre and even dangerous, weight loss will occur as long as energy intake is less than energy expenditure (i.e. calories in < calories out).

–          Lifestyle strategies that help individuals identify and modify their eating behaviour and patterns of eating.  When people understand why they eat and when they eat, it is easier for them to make long-term lifestyle changes.

–          Exercise and increased physical activity to help people attain and maintain a healthy body weight.

–          Food intake is sometimes addressed pharmacologically by doctors by using drugs such as Orlistat (which blocks lipase, an enzyme involved in fat absorption).

–          Surgical approaches provide the most dramatic weight loss and outside of the cosmetic value, may have a role in reducing long-term mortality and the incidence of diabetes [Bray].

 

Role of Green Tea Catechins in Weight Loss

Green tea is the unfermented leaves of the Camellia sinensis plant and contains a number of biologically active compounds called catechins and epigallocatechin gallate (EGCG) makes up almost 30% of the solids in green tea [Kim et al].  Recent studies have found that green tea catechins, especially EGCG play a significant role in both weight loss and body fat composition.

Green Tea Catechins and “Metabolic Syndrome”

Several large-scale population studies have linked increased green tea consumption with significant reductions in “metabolic syndrome” which is a cluster of diseases that include;

–          insulin resistance or diabetes

–          hyperinsulinemia (high levels of insulin in the blood)

–          cardiovascular diseases; high blood pressure & coronary heart disease

–          obesity

It is thought that epigallocatechin gallate (EGCG), the most abundant catechin in green tea, mimics the actions of insulin.  This has positive health implications for people with insulin resistance or diabetes [Kao et al] and EGCG also lowers blood pressure almost as effectively as the ACE-inhibitor drug, Enalapril, having significant implications for people with cardiovascular disease [Kim et al].

 

Green Tea in Population Studies

Population studies and several randomized controlled studies (where one group is “treated” and the other group is not) have shown that waist circumference is smaller and levels of body fat is less the more green tea consumed  [Phung et al] .  The anti-obesity effects of green tea are usually attributed to the presence of catechins [Naigle].

 

Green Tea Catechins

While catechins make up ~ 30% of green tea’s dry weight (of which 60–80% are catechins) oolong and black tea, which are produced from partially fermented or completely fermented tea leaves contains approximately half the catechin content of green tea.

Drinking 8-10 cups of green tea per day is enough to increase blood levels of EGCG into a measurably significant range [Kim et al]. Matcha, a powdered green tea used in the Japanese tea ceremony and popular in cold green tea beverages such as bubble tea, contains 137 times greater concentration of EGCG than China Green Tips (Mao Jian) tea [Weiss et al].

 

Green Tea Catechin Content of Brewed Green Tea vs Matcha Powder

A typical cup (250 ml) of brewed green tea contains 50–100 mg catechins and 30–40 mg caffeine, with the amount of tea leaves, water temperature and brewing time all affecting the green tea catechin content in each cup.

A gram (~1/3 tsp) of matcha powder contains 105 mg of catechins (of which 61 mg are EGCs) and contains 35 mg of caffeine. Most matcha drinks made at local tea and coffee houses are made and served cold and contain ~1 tsp of matcha powder which contains ~315 mg of catechins (of which ~183 mg are EGCs).  Since there is no brewing time involved in the preparation of cold matcha beverages, the amount of catechins remains relatively constant in each cup. Variation in catechin content in matcha powder is largely due to where the plant is grown and how it is processed.

 

Weight Loss Effect of Green Tea Catechins

A 2009 meta-analysis (combining the data from all studies) of 11 green tea catechin studies found that subjects consuming between 270 to 1200 mg green tea catechins / day (i.e. 1 – 4 tsp of matcha powder per day) lost an average of 1.31 kg (~ 3 lbs) over 12 weeks [Hursel].

 

Decreased Body Fat & Abdominal Fat even without Significant Weight Loss

The effect of green tea catechins on body composition is significant even when the weight loss between “treated” and “untreated” groups is small (~5 lbs in 12 weeks).

Even with such small amounts of weight loss;

– the total amount of abdominal fat decreases 25 times more with green tea catechin consumption than without it (−7.7 vs. −0.3%)

and

 total amount of subcutaneous abdominal fat (the fat just below the skin of the abdomen) decreases almost 8 times more with green tea catechin consumption thank without it (−6.2 vs. 0.8%).

 

How do Green Tea Catechins Work?

The mechanisms by which green tea catechins reduce body weight and reduce the amount of total body fat and in particular reduce the amount of abdominal fat are still being investigated.  It is currently thought that green tea catechins;

–          increased thermogenesis; i.e. increased heat production which would result in increased energy expenditure (or calorie burning)

–          increase fat oxidation (or using body fat as energy)

–          decrease appetite

–          down-regulation of enzymes involved in liver fat metabolism

–          decrease nutrient absorption

 

Green Tea Absorption

Green tea catechins are absorbed in the intestine.  Since the presence of food significantly decreases their absorption, green tea catechins are best taken 1/2 an hour before meals or 2 hours after meals.

The timing of green tea catechin intake may also affect the absorption and metabolism of glucose.  A study by Park et al found that when green tea catechins were given one hour before to a glucose (sugar) load, glucose uptake was inhibited and was also accompanied by an increase in insulin levels. Taking green tea catechins an hour before consuming highly sweet foods may be beneficial for those with insulin resistance or diabetes.

Green Tea Catechins and Milk

There seems to be some dispute in the literature as to whether the casein (a protein) in milk binds green tea catechins, making them unavailable for absorption in the body, which is why matcha drinks are often made with non-milk beverages such as soy milk, almond milk or rice milk (that don’t have casein).

Conclusion

Consuming between 1 – 4 tsp of matcha powder per day (270 to 1200 mg green tea catechins / day) is sufficient to result in weight loss of approximately 3 lbs in 12 weeks (with no other dietary or activity changes) and to significantly decrease body fat composition and reduce the quantity of abdominal fat.
 

***Warning to pregnant women***

While EGCG has also been found to be similar in its effect to etoposide anddoxorubicin, a potent anti-cancer drug used in chemotherapy [Bandele et al], high intake of polyphenolic compounds during pregnancy is suspected to increase risk of neonatal leukemia. Bioflavonoid supplements (including green tea catechins) should not be used by pregnant women [Paolini et al].

BetterByDesign’s Recipe for Iced Matcha 

For those of you that have been asking what I am always drinking in that thermos…this is it!

 

Ingredients

–          1 tsp matcha (green tea) powder (contains ~315 mg catechins)

–          500 ml soy milk

–          crushed ice

 

Method

  1. Place 1 tsp matcha powder in a small stainless steel sieve and gently press through the sieve into a small bowl with the back of a small spoon
  2. Put the sieved matcha powder into a ceramic or glass bowl (not metal, as the tannins in the tea will react and give the beverage and “off” metalic taste)
  3. With a bamboo whisk (available at Japanese and Korean grocery stores), whisk 3 Tbsp boiled and cooled water into the matcha powder, until all the lumps are gone and the mixture is smooth
  4. Place 1/4 cup of crushed ice in the bottom of a tall (16 oz / 500 ml) glass
  5. Pour matcha and water mixture over ice in the glass
  6. Fill glass with soy milk (or almond milk or rice milk) *

* I use 2/3 unsweetened soy milk and 1/3 sweetened soy milk

Note: once the matcha is blended with the soy milk, the tannins in the green tea are neutralized and no longer react with metal, so the beverage can then be put in an insulated stainless steel cup.

 

References

Bandele, OJ, Osheroff, N. Epigallocatechin gallate, a major constituent of green tea, poisons human type II topoisomerases”.Chem Res Toxicol 21 (4): 936–43, April 2008.

Bray GA. Lifestyle and pharmacological approaches to weight loss: efficacy and safety. J Clin Endocrinol Metab 2008;93:S81–88.

Brown WJ, Williams L, Ford JH, Ball K, Dobson AJ. Identifying the energy gap: magnitude and determinants of 5-year weight gain in midage women. Obes Res 2005;13:1431–41.

Centers for Disease Control and Prevention (CDC). Overweight and obesity. http://www.cdc.gov/obesity/index.html accessed Nov 20. 2009

Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. Int J Obes (Lond) 2009;33:956–61.

Kao YH, Chang MJ, Chen CL, Tea, Obesity, and Diabetes, Molecular Nutrition & Food Research, 50 (2): 188–210, February 2006

Kim JA, Formoso G, Li Y, Potenza MA, Marasciulo FL, Montagnani M, Quon MJ., Epigallocatechin gallate, a green tea polyphenol, mediates NO-dependent vasodilation using signaling pathways in vascular endothelium requiring reactive oxygen species and Fyn, J Biol Chem. 2007 May 4;282(18):13736-45. Epub 2007 Mar 15.

Nagle DG, Ferreira D, Zhou YD. Epigallocatechin-3-gallate (EGCG): chemical and biomedical perspective. Phytochemistry 2006;67:1849–55.

Park JH, Jin JY, Baek WK, Park SH, Sung HY, Kim YK, et al. Ambivalent role of gallated catechins in glucose tolerance in humans: a novel insight into nonabsorbable gallated catechin-derived inhibitors of glucose absorption. J Phyisiol Pharmacol 2009;60:101–9.

Popkin BM. Recent dynamics suggest selected countries catching up to US obesity. Am J Clin Nutr 2010;91:284S–8S.

Phung OJ, Baker WL, Matthews LJ, Lanosa M, Thorne A, Coleman CI. Effect of green tea catechins with or without caffeine on anthropometric measures: a systematic review and meta-analysis. Am J Clin Nutr 2010;91:73–81.

Paolini, M, Sapone, A, Valgimigli, L, “Avoidance of bioflavonoid supplements during pregnancy: a pathway to infant leukemia?”. Mutat Res 527 (1–2): 99–101. (Jun 2003)

Rains, TM, Agarwal S, Maki KC, “Antiobesity effects of green tea catechins; a mechanistic review” J or Nutr Biochem 22(2011):1-7

Shields M, Connor Gorber S, Trembaly MS, Estimates of obesity based on self-report versus direct measures, Statistics Canada (StatsCan), http://www.statcan.gc.ca/pub/82-003-x/2008002/article/10569-eng.htm

Statistics Canada(StatsCan) – Overweight and Obese Adults (self-reported), 2011 http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11664-eng.htm

Weiss, DJ, Anderton CR, Determination of catechins in matcha green tea by micellar electrokinetic chromatography, Journal of Chromatography A, Vol 1011(1–2):173-180, September 2003

 

The Paleo Diet – Did it ever Prevent Hardening of the Arteries?

Atherosclerosis, or “hardening of the arteries” is thought to be a disease of modern human beings and believed to be related to current diet and lifestyle factors, however its prevalence has now been documented in pre-industrial populations from four totally different regions of the world, with very different dietary intakes.

The “Paleo Diet” is a modern style of eating based on an ancient diet believed to have be eaten during the Paleolithic era — a period of about 2.5 million years which ended around 10,000 years ago with the development of agriculture and grain-based diets.  Proponents of this diet argue that modern human populations eating diets thought to be similar to those of Paleolithic societies are largely free of  “diseases of affluence”, including atherosclerosis (hardening of the arteries).

The “Paleo Diet” consists mainly of fish, grass-fed pasture raised meats, eggs, vegetables, fruit, fungi, roots and nuts (and excludes grains, legumes/pulses, dairy products, potatoes, refined salt, refined sugar and processed oils).

But is atherosclerosis a disease of modern human beings related to our current diet and lifestyle factors?  Its prevalence in pre-industrial populations from four totally different regions of the world with very different dietary intakes, has now been documented.

The Study

A new study published in the peer-review journal The Lancet (March 10, 2013) has obtained whole body CT scans of 137 mummies from four different geographical regions representing entirely different populations (ancient Egypt, ancient Peru, the Ancestral Puebloans of southwest America, and the Unangan of the Aleutian Islands) spanning more than 4000 years of history.  The ancient Egyptians and Peruvians were farmers, the ancestral Puebloans were forager-farmers, and the Unangans of the Aleutian Islands were hunter-gatherers without agriculture.  None of the cultures was known to be vegetarian and all were believed to be quite physically active.

Diagnosis of Atherosclerosis

For the purpose of the study, a diagnosis of atherosclerosis was made if a calcified plaque was seen in the wall of an artery and probable if calcifications were seen along the expected course of an artery

Findings of the Study

Researchers identified atherosclerosis in more than a third of the mummified specimens, raising the possibility that humans have a natural predisposition to the disease. In total, whole-body CT scans were performed on 137 mummies, including 76 ancient Egyptians, 51 ancient Peruvians, five ancestral Puebloans, and five Unangan hunter-gatherers. Probable or definite atherosclerosis was evident in 34% of the mummies; 29 ancient Egyptians, 13 ancient Peruvians, two ancestral Puebloans and three Unangan mummies.

Significance of these Findings

Atherosclerosis was considerably more common in ancient populations than previously believed.

In a presentation at a recent conference (March 9 – 11, 2013) at the American College of Cardiology 2013 Scientific Sessions in San Francisco, California led by Dr Randall Thompson (University of Missouri-Kansas City School of Medicine) and reported on Medscape Today News, March 16, 2013 the lead researcher of the study said;

our findings greatly increase the number of ancient people known to have atherosclerosis and show for the first time that the disease was common in several ancient cultures with varying lifestyles, diets, and genetics, across a wide geographical distance and over a very long span of human history. These findings suggest that our understanding of the causative factors of atherosclerosis is incomplete and that atherosclerosis could be inherent to the process of human aging.”

Ancient Paleo Diet

According to Dr. Thompson, the diets of these peoples were quite different from each other, as were the climates.  Local plant foods that were indigenous to each population group varied greatly over the wide geographical distance between these regions of the world. Fish and game were present in all of the cultures, but protein sources varied from domesticated cattle among the Egyptians to an almost entirely marine diet among the Unangans.”

Age and Cause of Death

Based on calculations using architectural changes in the bone structures, the average age of death was 43 years old and age was positively correlated  with atherosclerosis. Researchers note that all four populations lived at a time when infections would have been a common cause of death and the high level of chronic infection and inflammation might have promoted the inflammatory aspects of atherosclerosis.  These findings are consistent with the accelerated course of atherosclerosis seen in patients with rheumatoid arthritis and lupus today.

Conclusion

Atherosclerosis is not just a modern phenomenon; it was common in four pre-industrial populations across a wide span of human history, including a pre-agricultural hunter-gather population. The presence of atherosclerosis in pre-modern human beings suggests that the disease is an inherent component of human aging and not associated with any specific diet or lifestyle.

References

Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations, The Lancet, Thompson RC, Allam AH, Lombardi GP et al, Published online March 10, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60598-X

Medscape Today News, March 16, 2013

Health Benefits of Chocolate

While eating unlimited amounts of any calorically-dense food such as chocolate may increase the risk of overweight or obesity, consumption of chocolate, especially dark chocolate has been associated with several health benefits.

While eating unlimited amounts of any calorically-dense food such as chocolate may increase the risk of overweight or obesity, consumption of chocolate, especially dark chocolate has been associated with several health benefits.

What is chocolate?

Chocolate is a food produced from the seed of the tropical theobroma cacao tree.  The seeds of the cacao tree have an intense bitter taste and must be fermented to develop the flavor.  After fermentation the beans are dried then cleaned and roasted and then the shell is removed to produce cacao nibs. The nibs are then ground to cocoa mass; pure chocolate in rough form. Since the cocoa mass is usually liquefied then molded with or without other ingredients, it is called chocolate liquor.

The liquor also may be processed into two components: cocoa solids & cocoa butter.  The cocoa solids are responsible for the brown colour in dark and milk chocolate.  Dark chocolate contains primarily cocoa solids and cocoa butter, in varying proportions.  Milk chocolate combines cocoa solids, cocoa butter or other fat, and sugar as well as milk products such as milk powder or condensed milk.  White chocolate contains cocoa butter, sugar and milk solids but no cocoa solids and therefore really isn’t chocolate at all.

Chocolate as an ancient medicine

Recognition of cocoa’s health properties is nothing new. As far back as the 16th-century Spanish priests were aware of the nutritional properties of the highly prized Mayan cocoa drink and sanctioned its use as a food substitute during periods of fasting.

Chocolate and cardiovascular health

It is well known that certain plant polyphenols, in particular the flavonoids, act to lower the risk of both cardiovascular disease and cancer.  Flavanols are known to be present in red wine, tea and various fruits and berries but dark chocolate also contains large amounts of flavanols and has a cardio-protective role in the diet.

Chocolate and cough suppression

The presence of theobromine in chocolate has been shown to be more effective than codeine when it comes to suppressing a cough.  According to a 2005 study published in the FASEB Journal, researchers induced coughing in 10 healthy volunteers (using capsaicin from chili pepper) and then measured how much capsaicin was needed to induce a cough after subjects had taken theobromine (found in dark chocolate), codeine or a placebo.  In comparison with the placebo, when subjects had taken theobromine they needed around a third more capsaicin to produce a cough, whereas they needed only marginally higher levels of capsaicin after taking codeine.  Theobromine works by suppressing the activity of the vagus nerve which causes coughing.  Best of all, theobromine doesn’t produce any adverse effects on the cardiovascular or central nervous systems. Maria Belvisi, one of the study’s authors commented: “Normally the effectiveness of any treatment is limited by the dosage you can give someone. With theobromine having no demonstrated side effects in this study, it may be possible to give far bigger doses, further increasing its effectiveness”.

Chocolate’s beneficial effect on blood pressure

According to a 2002 study, eating just 30 calories a day of dark chocolate per day can help lower blood pressure without weight gain or other side effects.  This effect has been attributed to dark chocolates high content of cocoa polyphenols,

Researchers found that those who ate 6.3 gm of dark chocolate per day of dark chocolate (about 30 calories and 30 mg of polyphenols) saw their average systolic blood pressure drop by 2.9 mm Hg and diastolic BP by 1.9 mm Hg.  Those diagnosed with hypertension (high blood pressure) had their blood pressure drop by 18% as a result of consuming 6.3 gm of dark chocolate. Furthermore, none of the subjects in the study experienced any changes in body weight, blood lipids (cholesterol) or blood glucose (sugar) levels.

Subjects that ate the same amount of white chocolate (which contains no cocoa and therefore no polyphenols) had no change in their systolic or diastolic blood pressure.  Although the magnitude of the blood pressure reduction was small, the effects are clinically noteworthy.

On a population basis, it has been estimated that a 3-mm Hg reduction in systolic blood pressure would reduce the relative risk of death by stroke by 8 % and of death from coronary artery disease by 5%, and of all-cause death by 4%.

It is proposed by one of the authors of a 2006 study (Dr. Naomi Fisher) that the decrease in arterial stiffness noted in subjects after consuming 100 gm of dark chocolate was due to the effect of the flavonoids in the cocoa acting on an enzyme called nitric oxide synthase; resulting in dilatation of blood vessels,  improve kidney function and lower blood pressure.

Chocolate toxic to pets?

Cocoa solids (found in dark chocolate and milk chocolate) contains alkaloids such astheobromine and phenethylamine which, as noted above have some positive physiological benefits in humans but it is the presence of theobromine which renders it toxic to some animals, including dogs and cats.  Because white chocolate does not contain any cocoa solids, and thus no theobromine, it can be safely eaten by animals.

Other Benefits of Chocolate:

Chocolate also holds benefits apart from protecting your heart:

1. It stimulates endorphin production, which gives a feeling of pleasure.

2. It contains serotonin, which is a neurotransmitter that has an anti-depressant effect

3. It contains small quantities of phenylethylamine, another neurotransmitter that creates feelings of attraction and excitement in the brain’s pleasure centre. (Maybe that’s where chocolate came to have a reputation as an aphrodisiac?)

4. It tastes good!

A little goes a long way

Chocolate is still a high-calorie, high-fat food. Most of the studies done used no more than 100 grams, or about 3.5 ounces, of dark chocolate a day to get the benefits. One bar of dark chocolate has around 400 calories. If you eat half a bar of chocolate a day, you must balance those 200 calories by eating less of something else.

To indulge a chocolate habit without regrets, choose dark varieties containing at least 70 % cocoa solids and check low levels of cocoa butter. Try to make a little go a long way.  Research indicates that you get maximum benefit with fewer ill effects from just one or two squares of dark chocolate per day.

References

Fisher ND, Hollenberg NK. Aging and vascular responses to flavanol-rich cocoa. J Hypertens. 2006 Aug; 24(8):1575-80.

Francene M Steinberg, Monica M Bearden, Carl L Keen, Cocoa and chocolate flavonoids: Implications for cardiovascular health, JADA 2003; 103(2)215-223,

Taubert D, Renate R, Clara L, et al. Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide., JAMA 2010; 298 (1): 49-60.

Usmani OS, Belvisi MG, Patel HJ et al, The FASEB  Journal 2005 Vol 19, pgs 231-233Theobromine inhibits sensory nerve activation and cough



	

Multivitamins in the prevention of cardiovascular disease

Multivitamins are used to prevent vitamin and mineral deficiency; however there is a common belief that taking multivitamins may prevent cardiovascular disease (CVD). This study published in the November 7, 2012 of the Journal of the American Medical Association demonstrated among this population of US male physicians that taking a daily multivitamin for more than a decade of treatment and follow-up did not reduce major cardiovascular events, including nonfatal myocardial infarction (MI), non-fatal stroke and CVD mortality.

Multivitamins are used to prevent vitamin and mineral deficiency; however there is a common belief that taking multivitamins may prevent cardiovascular disease (CVD).  This study published in the November 7, 2012 of the Journal of the American Medical Association demonstrated among this population of US male physicians that taking a daily multivitamin for more than a decade of treatment and follow-up did not reduce major cardiovascular events, including nonfatal myocardial infarction (MI), non-fatal stroke and CVD mortality.

THE STUDY

The Physicians’ Health Study II (PHS II) is a randomized, double-blind, placebo-controlled trial investigating several different vitamins including beta-carotene, vitamin E, vitamin C and a daily multivitamin. PHS II launched in 1997 with continued treatment and follow-up through 2011. The other three arms of the study looking at beta-carotene, vitamin E and vitamin C have been previously published. This study on the use of multivitamins, was just released November 7, 2012 and is entitled “Multivitamins in the Prevention of Cardiovascular Disease in Men – The Physicians’ Health Study II Randomized Controlled Trial”

SUBJECTS

A total of 14,641 male US physicians initially aged 50 years or older, including 754 men with a history of CVD at randomization, were enrolled and randomly assigned to either receive a daily multivitamin or a placebo. Of men enrolled in PHS II, 5% had a history of MI or stroke.

THE RESULTS

Over an average follow-up of ~11 years, 1732 CV events occurred, but this rate of CV events was no higher among men taking placebo than those taking a daily multivitamin.

There was no statistically significant difference in rates of MI, all stroke, hemorrhagic stroke, ischemic stroke, congestive heart failure, angina, coronary revascularization, CVD mortality, or overall mortality.

No major differences in negative effects were seen between the group receiving the multivitamin or the placebo

CONCLUSION

There is a concern that people who think they are benefiting from taking a daily multivitamin may be less likely to participate in preventive health behaviors, such as diet and exercise that are both known to reduce the risk of cardiovascular disease. Furthermore, people with heart disease or risk factors may continue to lead unhealthy lives yet take daily vitamins supplements in the hope of reducing their risk of future problems while avoiding making the needed lifestyle changes. This distraction from effective CVD prevention is viewed as the main ‘hazard’ of daily multivitamin supplementation.

The PHS II participants as a whole, exercised regularly, ate reasonably well, and didn’t smoke so the group probably represented, on average, a well-nourished population who already have adequate or optimum intake levels of nutrients, for which supplementation may offer no benefits. Multivitamin supplementation may play a role in nutritionally at-risk populations or those with nutritional deficiencies.

HOW TO KNOW IF YOU ARE GETTING ADEQUATE NUTRIENTS?

The best way to determine if you are getting all the nutrients in the amounts you need for your age and gender is to have your diet assessed by a Registered Dietitian.  BetterByDesign Nutrition has several different packages to meet your needs.  Remember, that visits to a Registered Dietitian are covered by most extended benefit plans.  As well, many companies have Employment Assistance Programs (EAPs) that will cover short term visits to a Registered Dietitian.  Click on the “Assessment Options” to see the various services we offer.

New Statistics Canada report finds almost a third of Canadian children are overweight or obese

A new Statistics Canada report released on September 20, 2012 finds that almost a third of 5- to 17-year olds were classified as overweight or obese in 2009 to 2011. While the percentage who were overweight was similar across age groups, the prevalence of obesity was almost double in boys overall than girls.

A new Statistics Canada report released on September 20, 2012 finds that almost a third (31.5%) of 5- to 17-year olds were overweight (19.8%) or obese (11.7%) in 2009 to 2011. While the percentage who were overweight was similar across age groups, the prevalence of obesity was almost double in boys overall than girls (15% versus 8%). In children aged 5 to 11 years, boys are more than three times likely to be obese (19.5%) compared to girls of the same ages (6.3 %). Experts say that the new obesity cutoffs of the World Health Organization standards used to measure obesity were not enough to explain these findings.

THE STUDY POPULATION

The study (Obesity in Children and Adolescents: Results from the 2009 to 2011 Canadian Health Measures Study) was based on actual measured heights and weights of 2,123 children and adolescents in Canada aged 5 to 17, between the years 2009 and 2011.

BMI – MEASURE OF OBESITY

The data involved only one measure of overweight, BMI (Body Mass Index) which is the defined as a person’s body mass divided by the square of their height.  Another recent Canadian study referred to in this report demonstrated that over time, waist circumference among Canadians of all ages has increased more than BMI, indicating the need to monitor waist circumference.

BODY FAT & WAIST CIRCUMFERENCE – SIGNIFICANCE

Evidence for adults indicates that changes in the distribution of body fat such as increased waist circumference, are associated with elevated health risk. Weight carried around the abdomen (in so-called “apple” shaped people) is a greater risk than weight distributed overall or in the hips and thighs (as in so-called “pear-shaped” people). Even when the prevalence of BMI doesn’t change, distribution of body fat centered around the waist is associated with increased health risk.

CHILDREN WITH ADULT-ONSET ILLNESSES

Excess weight in childhood is increasingly being linked to what were once thought to be adult-onset illnesses including Type 2 diabetes, high blood pressure (hypertension), abnormal blood fats / high cholesterol, hardening of the arteries and non-alcoholic fatty liver disease. Studies have shown that adolescents who are overweight have a 14 times increased risk of having a heart attack before they turn 50. Children that are obese also have higher levels of depression and low self-esteem and are more likely to be teased or bullied at school.

EFFECT OF “SCREEN TIME” 

The amount of time spent in front of a TV, computer, video game or texting or surfing on smart-phones (so-called “screen-time”) has been found to be strongly correlated with childhood obesity. Children and adolescents that spend two hours or more of screen time per day are twice as likely to be overweight or obese than those who spend an hour or less of screen time.  Studies have also shown that screen time is higher amongst boys than girls, which may be related to higher rates of overweight and obesity found in boys compared with girls.

WHAT DOES THIS STUDY MEAN TO ME?

It would be helpful to encourage children of all ages to participate in regular daily physical activity and decrease their “screen time” to less than 1 hour a day (half the current amount associated with childhood overweight and obesity).

As well, to make sure that children (as well as adults) are within a healthy body weight, its recommended that they have their waist circumference monitored regularly as well as having their Body Mass Index (BMI) calculated and body fat percentage determined.

Our Dietitian is very experienced working with children and can assess your child”s current weight and nutritional status and make recommendations to reduce their risk of acquiring diseases including Type 2 diabetes, high blood pressure (hypertension), abnormal blood fats / high cholesterol and non-alcoholic fatty liver disease.

If you are concerned about weight management in you or your children,  please click on the “Contact Us” tab to find out how to contact us.

 

Vitamin D status of Canadians – from the Canadian Health Measures Survey

A Statistics Canada Report released in 2010 indicated that while 90% of Canadians 6- to 79-years old have enough Vitamin D in their blood for bone health, 10% (or roughly 3 million people) have concentrations considered to be inadequate and 1.1 million Canadians (or 4% of the population) is actually Vitamin D deficient; levels low enough to cause rickets in children and osteoporosis in adults. The highest prevalence of deficiency is in men aged 20 to 39 years old, with about 7% considered Vitamin D deficient.

A Statistics Canada Report released in 2010 indicated that while 90% of Canadians 6- to 79-years old have enough Vitamin D in their blood for bone health, 10% (or roughly 3 million people) have concentrations considered to be inadequate and 1.1 million Canadians (or 4% of the population) is actually Vitamin D deficient; levels low enough to cause rickets in children and osteoporosis in adults.  The highest prevalence of deficiency is in men aged 20 to 39, with about 7% considered Vitamin D deficient.

WHAT IS VITAMIN D?

Vitamin D is a fat-soluble vitamin that is naturally present in very few foods and is added to others (especially dairy products). Vitamin D is also produced in the body when ultraviolet rays from the sun makes contact with exposed skin and triggers vitamin D synthesis.

WHAT DOES VITAMIN D DO?

Vitamin D is essential for bone growth and bone remodeling but without sufficient vitamin D, bones can become thin, brittle, or misshaped. Together with calcium, vitamin D helps protect older adults from osteoporosis and children against rickets. Vitamin D is also known to be associated with a lower risk of breast and colon cancer, some cardiovascular disease and other diseases like multiple sclerosis.

HOW MUCH IS ENOUGH?

Vitamin D is measured in nanomoles per litre (nmol/L).

  • Levels below 27.5 nmol/L is are considered to indicate deficiency.
  • Levels below 37.5 nmol/L are considered inadequate for bone health
  • It is suggested that 75 nmol/L is optimal for overall health.
THE STUDY

“Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey” was based on data from the Canadian Health Measures Survey (CHMS) which collected physical measures of health and wellness from a nationally representative sample of Canadians aged 6 to 79 years, including blood and urine samples.

Data

Data are from 5,306 individuals aged 6 to 79 years from all regions of Canada, representing all ages, both genders and all racial backgrounds. Measurement of Vitamin D as 25-hydroxyvitamin D [25(OH)D] concentrations were determined from blood tests, and factors known to affect vitamin D status were also assessed.

Findings

Ten percent of Canadians (or roughly 3 million people) have concentrations considered to be inadequate and 1.1 million Canadians (or 4% of the population) is actually vitamin D deficient; levels low enough to cause rickets in children and osteoporosis in adults.  The highest prevalence of deficiency is in men aged 20 to 39; with about 7% considered vitamin D deficient.

An estimated 4% of the population (5% of men and 3% of women) had levels indicating vitamin D deficiency.  The highest prevalence of deficiency (7%) was among men aged 20 to 39 years of age.

The report states that much higher concentrations (> 75 nmol/L) are needed for overall health and disease prevention and according to this report only 1/3 of people in Canada are above this level. 

Frequent milk consumption was related to better vitamin D levels in people of all ages; with those that drank milk more than once a day averaging 75 nmol/L.  Even with drinking milk more than once a day, vitamin D levels were still considered inadequate for overall health and disease prevention.   Those  that drank milk less than once a day had Vitamin D levels of 63 nmol/L

The average difference between people whose racial background was white (Caucasian) and people of other racial backgrounds was approximately 19 nmol/L, with whites having higher levels of Vitamin D.

SOURCES OF VITAMIN D

Vitamin D comes from foods and supplements, and from sun exposure.

Food Sources

There are only small amounts of vitamin D naturally occurring in foods such as oily cold-water fish (85 gm of light canned tuna contains 200 IU) and only a small amount of vitamin D is found in fortified foods such as milk (1 cup of milk contains 100 IU of vitamin D).

Sun Exposure

Vitamin D can be made by the body when the skin is exposed to sunlight. During the spring and summer months in Canada, daily sun exposure (if not wearing sunscreen or clothes that cover much of the body) may produce sufficient amounts of vitamin D, however many people avoid this due to the increased risk of skin cancer.

Even in sunny parts of Canada, Vitamin D production from the sun from late October to early March is insufficient and Vitamin D supplements are recommended.

As well, the skin’s ability to produce vitamin D drops with age, putting people older than 50 years of age, at risk.

Additional factors such as the time of day, amount of cloud cover, smog and the natural colour of one’s skin (melanin content) all affect the amount of vitamin D synthesis available.

VITAMIN D FROM THE SUN versus USE OF VITAMIN D SUPPLEMENTS

In northern climates, such as Canada which is above the 49th parallel, there are insufficient UV rays for 6 months of the year or more for adequate vitamin D synthesis.

The Canadian Cancer Society recommends that adults living in Canada should consider taking Vitamin D supplementation of 1,000 international units (IU) a day during the fall and winter months or year round if they are older (>50 years of age), have dark skin, don’t go outside often or if they do, wear sunscreen or clothing that covers most of their skin.

HOW DO I MAKE SURE TO GET ENOUGH VITAMIN D?

If you are an adult under the age of 50 years of age living in Canada, it is recommended that you supplement your diet with 1000 IU Vitamin D / day, more so if you are living in the Lower Mainland where there is often inadequate sunshine, even in the summer months.

Our Registered Dietitian can assess your diet and make recommendations to ensure you are getting sufficient micro-nutrients (vitamins and minerals), including Vitamin D.

Canadian study reports that cardiovascular risk is higher among certain ethnic groups

A study published in May 2010 in the Canadian Medical Association Journal and based on data conducted over an 11 year period was the first to compare cardiovascular risk factors and associated heart disease and stroke prevalence across the four major racial-ethnic groups living in the same geographic area, with a similar living environment and similar access to health care. The report found that Whites (Caucasian), South Asians, Blacks and Chinese had striking differences in cardiovascular risk profiles.

A study published in May 2010 in the Canadian Medical Association Journal and based on data conducted over an 11 year period was the first to compare cardiovascular risk factors and associated heart disease and stroke prevalence across the four major racial-ethnic groups living in the same geographic area, with a similar living environment and similar access to health care.  The report found that Whites (Caucasian), South Asians, Blacks and Chinese had striking differences in cardiovascular risk profiles.

THE STUDY

The study entitled “Comparison of Cardiovascular Risk Profiles Among Ethnic Groups” was based on population health surveys between 1996 and 2007 and was conducted by the Toronto-based Institute for Clinical Evaluative Sciences.  It compared data from 154,653 Caucasians (Whites), 3,038 Chinese, 3,364 South Asians and 2,742 blacks who participated in Statistics Canada’s cross-sectional national population health survey between 1996 and 2007.

RISK FACTORS

Risk factors for cardiovascular disease include smoking, diabetes, obesity, hypertension (high blood pressure) as well as psychological or social stress.

FAVORABLE DIFFERENCES IN RISK BETWEEN ETHNIC GROUPS

The study reported that Chinese had the most favorable cardiovascular risk factor profile with only 4.3% of the population reporting two or more major cardiovascular risk factors, such as smoking, diabetes, obesity and hypertension (high blood pressure).

South Asians had the next most favorable cardiovascular risk profile (7.9%), followed by Whites (10.1%) and Blacks (11.1%).

PREVALENCE OF RISK FACTORS BY RACE

The study also found that smoking, obesity and stress were significantly more common in Whites, while diabetes and hypertension were much more prevalent among Blacks and South Asians.

WHAT COULD THE STUDY MEAN FOR YOU?

Risk factors such as smoking, diabetes, obesity and hypertension (high blood pressure) are considered to be related to 90% of risk factors for cardiovascular diseases, so being aware of these ethnic differences can help you, your doctor and your dietitian make lifestyle changes specific to your ethnicity, including;

  • diabetes and hypertension lifestyle intervention targeted to high-risk South Asians and Blacks
  • obesity-prevention programs for Black women and White men and women
  • encouraging physical activity among South Asian and Chinese populations

CONSULTING OUR REGISTERED DIETITIAN

If you have any of the risk factors known to be prevalent for your ethnic background, consider consulting with our Registered Dietitian.  She is a food and nutrition expert and is knowledgeable and experienced to help you make the lifestyle changes needed to lower your risk of cardiovascular disease.